PMC4180505_01
Cutaneous ulceration before and after steroid therapy; pathology and PET/CT findings of the cutaneous ulceration. (A-1) The right knee cutaneous ulcer measured 4 cm before steroid therapy. (A-2) One month after the treatment, it measured < 1 cm and showed granulation tissue growth. (B) A biopsy of the edge of the ulcer revealed a mild lymphocytic infiltrate in the superficial dermis; however, no obvious findings of vasculitis were observed. (C) FDG PET/CT demonstrated increased tracer uptake in the ulcer, suggesting inflammation.
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Fig1
She also had a skin ulcer over the right patella that had appeared 1 month earlier (Figure  1A-1). Moreover, FDG uptake was observed in the skin ulcer on the knee (Figure  1B). Although skin from the ulcer was biopsied, no obvious vasculitis findings were observed (Figure  1C). The right knee skin ulcer also shrank markedly (Figure  1A-2).
Thoracic contrast enhanced CT findings of aortitis before steroid therapy. Thoracic contrast-enhanced CT demonstrated thickening of the aortic wall at each following level with a contrast effect, and the non-contrast layered area on the lumen. A. brachiocephalic artery and left subclavian artery. B. aortic arch. C and D. ascending aorta.
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Fig2
Thoracic-abdominal computed tomography (CT) was performed to investigate the persistently elevated inflammatory markers and showed no evidence of pneumonia, while dilation of the ascending and descending aorta, aortic arch, brachiocephalic artery, and left subclavian artery were noted (Figure  2). The right knee skin ulcer also shrank markedly (Figure  1A-2).
FDG-PET/CT findings of aortitis before and after steroid therapy. A-1 and A-2. FDG PET/CT showed increased tracer uptake in the ascending aorta, aortic arch, brachiocephalic artery, and left subclavian artery. B-1 and B-2. After steroid therapy, FDG-PET/CT showed a significant reduction in the FDG uptake in the same area.
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Fig3
Subsequently, fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) showed strong abnormal tracer uptake consistent with the dilated aortas on CT (Figure  3A).
Thoracic contrast-enhanced CT findings of aortitis before and after steroid therapy. A-1 and A-2. Before steroid therapy, the thoracic contrast-enhanced CT demonstrated thickening of the aortic wall at the level of the ascending aorta and aortic arch, brachiocephalic artery, and left subclavian artery with a contrast effect. B-1 and B-2. After steroid therapy, the thickening of the aortic wall had disappeared completely.
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Fig4
On day 28 following steroid therapy initiation, follow-up CT showed that the dilation of the aorta had disappeared completely (Figure  4).