The bias in the nomenclature of large-vessel vasculitis.

Abstract

Dear Editor, A 68-year-old man of Northern European ancestry presented with a 3-month history of constitutional symptoms to his general practitioner. The detection of a normochromic normocytic anaemia, an acute phase response and an elevated prostate-specific antigen prompted a referral to a rapid diagnostic service for cancer. A CT scan of the thorax, abdomen and pelvis did not detect any solid tumours but commented on thickened aorta. An urgent referral was made to the vasculitis clinic. In the interim he received a short course of prednisolone which had finished more than a week ago. On attendance in vasculitis clinic, he had no organ-specific symptoms. Constitutional symptoms included weight loss of >5 kg, drenching night sweats and fatigue. He reported feeling slightly better over the last few weeks. He did not have any risk factors for atherosclerosis. On direct questioning, he admitted to a mild frontal headache (which had been reported as being absent in the primary care referral letter), anterior neck pain and symmetrical shoulder pain. On examination, there were no nail changes or detectable lymphadenopathy. The radial pulses and blood pressure were difficult to elicit in both arms, but the extremities appeared well perfused. There were harsh bruits over both subclavian and axillary arteries. Carotid arteries did not exhibit bruits and were non-tender. There were no abnormalities in relation to the superficial temporal arteries.