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[Takayasu's arteritis without manifest arterial stenoses as a cause of fever of unknown origin].

HISTORY AND CLINICAL FINDINGS
Two women, aged 59 and 53 years, presented with a history of several months of classical fever of unknown origin (FUO), largely normal physical findings, and elevated markers of systemic inflammation.


INVESTIGATIONS
After initially unremarkable findings, duplex-sonography detected circular, hypoechogenic wall thickening of the axillary arteries without hemodynamically significant narrowing of the lumen. 18F-fluorodeoxyglucose positrone emission-tomography (18F-FDG-PET) revealed marked vascular tracer uptake in the aorta and in the proximal arteries of the arms and legs. TREATMENT AND FOLLOW-UP: The diagnosis of Takayasu's arteritis was made, and high-dose prednisone treatment was initiated. Within a few days both patients became asymptomatic.


CONCLUSIONS
Large vessel vasculitis is a known cause of FUO. Duplex-sonography and 18F-FDG-PET are able to detect these disorders at an early stage before the onset of clinically relevant arterial obstructions. More widespread use of these techniques may show that large-vessel vasculitis is more common than previously thought.