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Innere Medizin 23. November 2016

Large vessel arteritis

Large vessel arteritis

A 70-year-old woman presented with an unstable gait for months. She complained of no pain and no general symptoms. Her medical history was unremarkable except for slight arterial hypertension. Upon general physical examination, no significant abnormal findings were present. The clinical neurological examination revealed an ataxic gait with a pathologic Romberg test and signs of sensory polyneuropathy. The laboratory tests showed elevated C‑reactive protein (7.29 mg/dL, normal <0.5 mg/dL) and elevated erythrocyte sedimentation rate (86 mm/h). A broad immunological, infectious and metabolic panel including tests for ANA, c‑ANCA, p‑ANCA, anti-Ro, anti-La, ACE, rheumatoid factor, immunofixation, neuro-oncological antibodies, vitamin B12, antibodies against hepatitis C, HIV, Treponema pallidum and Borrelia burgdorferi yielded regular results. Nerve conduction studies demonstrated a mixed polyneuropathy. Cerebral and spinal MRI and analysis of CSF were normal. Ultrasound of the superficial temporal arteries was unremarkable. 18F-FDG-PET showed marked FDG uptake in the aorta and the large vessels (Fig.  1 ). Large vessel arteritis was diagnosed and immunosuppressive therapy with steroids and methotrexate was implemented, which led to significant clinical improvement.

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