Journal of General Internal Medicine

, Volume 24, Issue 4, pp 532–536 | Cite as

Delayed Diagnosis of Biopsy-Negative Giant Cell Arteritis Presenting as Fever of Unknown Origin

  • Valentin S. Schäfer
  • Kenneth J. Warrington
  • Eric E. Williamson
  • Tanaz A. KermaniEmail author
Case Reports/Clinical Vignettes


Fever of unknown origin (FUO) presents a diagnostic challenge. Giant cell arteritis (GCA) may present with FUO and this entity should be included in the differential of elderly patients who present with constitutional symptoms. While a temporal artery biopsy is considered the gold standard for the diagnosis of GCA, a subset of patients with large vessel involvement by GCA may have a negative temporal artery biopsy and no cranial symptoms. We present a 79 year-old woman with FUO and negative temporal artery biopsies in whom diagnosis of GCA was delayed. Further imaging with CT-angiogram and positron emission tomography/computed tomography (PET/CT) scan showed diffuse extensive active vasculitis. The above case underscores the value of imaging studies in the evaluation of patients with FUO from occult large vessel vasculitis.


giant cell arteritis fever of unknown origin large vessel vasculitis 


Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Valentin S. Schäfer
    • 1
  • Kenneth J. Warrington
    • 1
  • Eric E. Williamson
    • 2
  • Tanaz A. Kermani
    • 1
    Email author
  1. 1.Department of Medicine, Division of RheumatologyMayo ClinicRochesterUSA
  2. 2.Department of RadiologyMayo ClinicRochesterUSA

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