Spinal Cord Presentation of Biopsy-Proven PET-Positive Giant Cell Arteritis.

Abstract

A 63-year-old man presented with sudden bilateral lower limb weakness and right sided sensory loss to pain and temperature, on a background of recently diagnosed biopsy-negative giant cell arteritis (GCA) treated with prednisone 50mg. ESR was normal. Somatosensory evoked potentials revealed central conduction delay. PET/CT imaging revealed major vessel hypermetabolism (Figure 1), indicative of active GCA confirmed on repeat temporal artery biopsy (Figure 2). Spinal cord involvement was suspected; intravenous steroids, cyclophosphamide, followed by tocilizumab were commenced with good response. Clinicians should be aware of rare manifestations of GCA1 and PET-CT might be helpful in evaluation of disease activity2.