Subclinical aortitis in a case of polychondritis

Abstract

A 36-year-old male presented with intermittent fever with chills, bitemporal headache, and acute red eye of 2 weeks duration. He also gave history of a self-limiting pain, swelling, and redness of the nose 4 weeks prior to the onset of symptoms. There was no history of joint pains, skin rash, or bowel or genitourinary complaints. Clinical evaluation revealed auricular chondritis, tracheal tenderness, and bilateral sensorineural hearing loss. Cardiovascular examination was normal. He was diagnosed as a case of relapsing polychondritis as he fulfilled modified McAdam’s criteria.1 He underwent FDG (18F-fluorodeoxyglucose)-PET (positron emission tomography) computed tomography (Figure 1) to evaluate extent of organ involvement which revealed FDG avid uptake in the root and arch of aorta (SUV max-2.6 compared to SUV max-1.3 of mediastinal blood pool), pleural and pericardial effusion, and fibroreticular opacities in bilateral basal segments. Relapsing polychondritis (RPC) is a multisystem of unknown aetiology. It is characterised by inflammation of cartilage with particular predilection to auricular, nasal, and tracheal cartilages. A wide variety of cardiovascular manifestations have been reported in RPC which include aortic and mitral regurgitation, Aortic arch syndrome and aortic aneurysm. Aortitis is a rare complication of RPC.2 The FDGPET is helpful in picking up subclinical inflammation in vasculitides.3