GIANT-CELL ARTERITIS MANIFESTING AS CHRONIC COUGH AND FEVER OF UNKNOWN ORIGIN

A 57-year-old white man sought medical attention because of chronic co ugh and fever of unknown origin, An extensive work-up over 4 weeks, in cluding repeated blood cultures, chest roentgenograms, a gallium scan, and computed tomographic scans of the sinuses, chest, and abdomen, wa s nondiagnostic. The patient was referred to our institution for bronc hoscopy. Further analysis of his history revealed that he had a headac he in conjunction with the cough and an episode of a flashing color de sign in his left eye 1 meek before assessment, The erythrocyte sedimen tation rate was 115 mm in 1 hour, A biopsy of the temporal artery show ed granulomatous inflammation of the vessel mall with multinucleated g iant cells, histiocytes, lymphocytes, plasma cells, and few eosinophil s, The multinucleated giant cells were closely related to the fragment ed elastic lamina. Corticosteroid therapy resulted in prompt resolutio n of the chronic cough and fever, Giant cell arteritis should be consi dered in the differential diagnosis of chronic cough.