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Correspondence
Role of FDG-PET/CT in diagnosis of aortitis caused by Takayasu arteritis and IgG4-related systemic disease
  1. Mohammed Shamim Rahman1,
  2. Lisa J Anderson2
  1. 1Department of Cardiology and Cardiothoracic Surgery, St George's Healthcare NHS Trust, London, UK
  2. 2Department of Cardiovascular Sciences, St George's University of London, London, UK
  1. Correspondence to Dr Mohammed Shamim Rahman, Department of Cardiovascular Sciences, St George's University of London, London SW18 5HB, UK; shamimrahman{at}doctors.net.uk

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The Authors’ reply We read with interest the comment1 on our recently published case of aortitis diagnosed with fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT2 and the data regarding the possible differential diagnoses.

The case presented was that of a 53-year-old woman who developed aortitis with no past history of inflammatory disease, presenting with severe aortic regurgitation. Despite extensive workup, no cause for her elevated inflammatory markers (C-reactive protein and erythrocyte sedimentation rate (ESR) both elevated) could be found until FDG PET/CT revealed aortic inflammation. Her autoimmune serology demonstrated only a mildly elevated rheumatoid factor and C3 complement level, with a normal autoantibody profile and no derangement in her immunoglobulin levels. A bone marrow biopsy, in addition, was also inconclusive with normal immunophenotyping and cytogenetics.

The initial differential diagnosis lay between a giant cell arteritis (GCA) and a Takayasu's arteritis (TA). She may have fulfilled the American College of Rheumatology criteria for diagnosing GCA published in 19903 in terms of presenting age and persistently raised ESR; however, an arterial biopsy was not undertaken due to the risks involved with any interventional procedures in these patients, and the convincing evidence of aortic inflammation by FDG PET/CT necessitating early treatment. TA was felt by our rheumatology specialists to be less likely, given her presenting age and ethnicity.

IgG4 was not specifically tested for as the inflammation was confined to the vascular system. However, we acknowledge that this condition would also have responded similarly to steroid therapy. Of note, the patient has now represented with a relapse following reduction in steroid dose and the requirement for any further investigations will be discussed with our colleagues. We would be happy to report to the authors, or more widely, any new findings.

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Footnotes

  • Contributors Both MSR and LJA provided the response detailed.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Commissioned; internally peer reviewed.

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