Lesson of the month: Large vessel vasculitis: A rare cause of transaminitis

TL;DR

A 73-year-old man with a fever and liver enzyme elevation was diagnosed with a rare condition called large vessel vasculitis after extensive testing.

Contribution

The paper highlights large vessel vasculitis as a rare but important cause of transaminitis in patients with fever of unknown origin.

Findings

The patient had transaminitis with no evidence of infection despite extensive testing.

CT-PET imaging confirmed large vessel vasculitis as the underlying cause.

The case emphasizes the need to consider vasculitis in patients with unexplained fever and liver enzyme abnormalities.

Abstract

We present the case of a 73-year-old male with pyrexia of unknown origin (PUO). He was a returned traveller from Southern Africa and underwent extensive investigation to rule out an infective cause. This was mostly unrevealing but there was a notable transaminitis (ALT predominant) with normal bilirubin level. He showed no serological or clinical improvement despite antibiotic treatment. Subsequent CT-PET showed high mural uptake in the thoracic and abdominal aorta and its major branches, confirming the diagnosis of Large Vessel Vasculitis (LVV). This case highlights the importance of considering LVV in patients with PUO and with transaminitis.

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