PMC9951122_01
PET scans showing the evolution of aortitis before (yellow arrow) and after (blue arrow) treatment. The first PET scan on the right shows grade 2 aortitis (yellow arrow), which was performed before treatment with tocilizumab. The second scan was performed after tocilizumab initiation with an improvement of aortic inflammation with grade 1 aortitis (blue arrow).. PET: Positron-emission tomography.
cureus-0015-00000034181-i01.jpg
PMC9951122_01_cureus-0015-00000034181-i01.jpg
FIG1
Therefore, given the maintenance of constitutional symptoms that caused functional limitation to the patient, a PET scan was performed, which showed a grade 2 aortitis extending from the aortic arch to the emergency of the renal arteries (Figure 1). ANCA vasculitis, led to the diagnosis of giant cell aortitis. Given the lack of clinical response to corticotherapy, tocilizumab was initiated (162 mg subcutaneous weekly), with a resolution of constitutional symptoms as well as normalization in inflammatory markers. A second PET scan was performed nine months after therapy with an improvement of inflammation in the previously affected areas with grade 1 aortitis (Figure 1).
Parasternal long-axis view on transthoracic echocardiogram showing an ascending aortic dilation of 44 mm (green arrow)
cureus-0015-00000034181-i02.jpg
PMC9951122_01_cureus-0015-00000034181-i02.jpg
FIG2
The transthoracic echocardiogram revealed an ascending aortic dilation of 44 mm (normal range: 17-33 mm) (Figure 2).