A 72-year-old male patient, previously healthy.
She presented with a 4-month history of holocraneal headache, weight loss of 10 kilos, malaise, asthenia, adynamia and night sweats.
On examination, the patient was pale and pale, with preserved muscle strength, without synovitis, preserved joint ranges, sensitivity in the epigastrium, without temporal lymphadenopathy, and without sensitivity to medication.
When asked, the patient reported a 30-minute left amaurosis with complete resolution and occasionally jaw pain due to chewing.
His study highlighted: hematocrit 32%, hemoglobin 10.2 g/dL, mean corpuscular volume 80fL (VR: 84-94), mean corpuscular hemoglobin concentration 33 g/dL (31-36).
Erythrosedimentation rate: 96 mm/h; leukocytes: 6,200 x mm3, normal formula, platelets: 440,000 x mm3; C-reactive protein: 80 mg/dl (VR: up to 5 mg/dl); normal lipid profile
Brain kinetics: ferremia 16 ug/dL (VR: 50-170), total iron binding capacity 224 mental ug/dL (VR: 250-450), transferrin 187 normal gastro-VR: 22
Enteroscopy with normal capsule endoscopy.
Alpha-fetoprotein and anti-cancer agent were normal.
Echocardiogram showed mild mitral regurgitation.
Computed axial tomography of thorax, abdomen and pelvis: normal.
Angiotac of vessels of the neck and chest: presence of mixed atheromatosis that predominates in the origin of the left subclavian artery and does not determine significant stenosis.
Given a clinical picture with no clear etiology and high suspicion of giant cell arteritis and to rule out a neoplasic origin, it was decided to perform positron emission tomography of the carotid artery bifurcation as well as an irregular ascending carotid artery tracer in diffuse descending and descending aorta.
Irregular focus of increased concentration of fluorodeoxyglucose (FDG) in the lower right anterior cervical region of 2.3 cm. Conclusion: FDG-PET without categorical evidence of malignant tumor hypermetabolic activity.
The finding on arterial walls suggests arteritis: the cervical focus makes it necessary to rule out thyroid nodule.
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Thyroid ultrasound: heterogeneous thyroid suggestive of chronic thyroiditis.
Given the findings described above, it was decided to start prednisone 50 mg/day (1 mg/kg), vo.
Temporal artery biopsy (obtained one week after starting treatment): granulomatous vasculitis with some multinucleated cells in the muscle wall around the vessels, accompanied by lymphocytes and giant cells.
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Three days after starting treatment, the patient reported a marked improvement in his general condition.
The control from the laboratory point to 2 weeks after the beginning of treatment showed a decrease in ESR to 20 mm/h, CRP to normal values and the patient performing his daily activities.
