Temporal arteritis and fever: Report of a case and a clinical reanalysis of 360 cases

The purposes of this article are to report a case with temporal arteritis ( TA) and to summarize and reanalyze the cases of temporal arteritis associat ed with fever in published articles for understanding better the clinical f eatures of TA. A case with biopsy-proven TA is reported. The publications w ith TA and fever were searched by using MEDLINE in English from 1966 to 199 9. Three hundred sixty cases of temporal arteritis associated with fever we re reanalyzed. The results showed that a case of biopsy-proven TA with typi cally clinical manifestation was initially misdiagnosed and that the reanal ysis of 360 cases revealed that the common clinical findings at presentatio n were abnormal temporal arteries, headache, low fever, loss of weight, pol ymyalgia rheumatica, jaw claudication, vision disorder, arthralgis or myaly ias, and ear pain and that the uncommon clinical findings at presentation w ere high fever, malaise, anorexia, breast pain, transient ischemic attack/s troke, cough, mental disorder, diarrhea, and uterine prolapse, etc. Laborat ory findings were the range of erythrocyte sedimentation rate (ESR) 14 to 1 49 with a mean of 97.0 mm/hr, white blood cells being normal or increased i n the range of 10.9 to 22.9 x 10(9)/L, hemoglobin level 7 to 16 g/dL, the p latelets count increased to 785 x 10(9)/L, and microscopic hematuria. The d iagnosis was made by a combination of clinical features, an increased ESR, a response to steroids, and, most specifically, temporal artery biopsy. The initial diagnosis was misdiagnosed in 38.2% of patients. In conclusion, th e features of TA associated with fever have not been widely appreciated yet . TA is a common cause of fever of unknown origin (FUO) in the elderly. TA should be considered when patients complain of common and uncommon manifest ations. An elevated ESR will aid in the diagnosis of TA, and temporal arter y biopsy will provide certainty.