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A 56-year-old male with no comorbidity was admitted for relapsing fever at 40°C with diarrhea and night sweats, 3 weeks after initial onset without microbiological screening in December 2020. Blood analysis showed C-reactive protein of 251.5 mg/l and negative cultures. A 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) revealed hypermetabolism highly suggestive of vasculitis affecting large and medium size arteries from upper and lower limbs, associated with highly hypermetabolic pan-colitis (Figure 1a). Stool culture was positive for Campylobacter coli. Temporal artery biopsy showed lymphocytic arteritis associated with eosinophils infiltrate, without any granuloma. A single dose of azithromycin allowed diarrhea resolution in 2 days and the inflammatory syndrome decreased after introduction of corticosteroids. The patient was treated for over 1 year, without relapse. FDG-PET/CT control after 2 years showed clear hypermetabolism regression (Figure 1b).
Figure 118F-fluorodeoxyglucose positron emission tomography/computed tomography showing (a) an aspect of highly active vasculitis affecting large and medium size arteries from both upper and lower limbs, associated with a highly hypermetabolic diffuse colitis and terminal ileitis, and hypermetabolic bilateral external iliac adenopathies. An associated aortitis was considered likely. (b) Almost complete hypermetabolism regression at control 2 years later.
Vascular involvements are rarely described in Campylobacter species infection but need specific follow-up to detect secondary aneurysm or stenosis. To our knowledge, diffuse vasculitis has never been previously described with Campylobacter coli [
]. Clinical and histological findings were not suggestive of giant cell arteritis, the main differential diagnosis for large size vessels vasculitis after 50 years. FDG-PET/CT may help diagnose post-infectious vasculitis in case of relapsing fever after an acute infection.
Declaration of competing interest
The authors have no competing interests to declare.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical approval
Ethical approval was not required.
Author contributions
Original draft preparation: NC and NFM; Review and editing: all authors.
References
Boissonneau S
Graillon T
Meyer M
Brunel H
Fuentes S
Dufour H.
Intracranial giant mycotic aneurysm without endocarditis and vasculitis: report of rare entity and review of literature.
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