Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2023; 11(4): 918-921
Published online Feb 6, 2023. doi: 10.12998/wjcc.v11.i4.918
Polyarteritis nodosa presenting as leg pain with resolution of positron emission tomography-images: A case report
Ji-Hyoun Kang, Jahae Kim
Ji-Hyoun Kang, Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju 61469, South Korea
Jahae Kim, Department of Nuclear Medicine, Chonnam National University Hospital & Medical School, Gwangju 61469, South Korea
Author contributions: Kang JH designed the research study, performed the research, analyzed the data and wrote the manuscript; Kim JH performed the research; All authors have read and approve the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ji-Hyoun Kang, MD, PhD, Associate Professor, Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, South Korea.
Received: September 27, 2022
Peer-review started: September 27, 2022
First decision: December 13, 2022
Revised: December 13, 2022
Accepted: January 12, 2023
Article in press: January 12, 2023
Published online: February 6, 2023

Although fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is widely used for diagnosis and follow-up of large sized vessel vasculitis, it is still not widely used for small to medium sized vessel vasculitis.


This is the case of a 68-year-old male who presented at the emergency department complaining of fever, myalgia, and bilateral leg pain of over two weeks duration, with elevated levels of C-reactive protein. He was subsequently admitted and despite the absence of clinically significant findings, the patient continued to exhibit recurrent fever. A fever of unknown origin workup, which included imaging studies using FDG-PET/CT, revealed vasculitis involving small to medium-sized vessels of both lower extremities, demonstrated by linear hypermetabolism throughout the leg muscles. The patient was treated with methylprednisolone and methotrexate after diagnosis leading to the gradual resolution of the patient’s symptoms. Three weeks later, a follow-up FDG-PET/CT was performed. Previously hypermetabolic vessels were markedly improved.


Our case report demonstrated that FDG-PET/CT has tremendous potential to detect medium-sized vessel inflammation; it can also play a crucial role in prognosticating outcomes and monitoring therapeutic efficacy.

Keywords: Positron emission tomography-computed tomography, Polyarteritis nodosa, Case report

Core Tip: The fluorodeoxyglucose-positron emission tomography/computed tomography can be an option to diagnose small to medium-sized vessel vasculitis and follow-up to assess on the extent and improvement of inflammation in patients with polyarteritis nodosa.