TY - JOUR T1 - Taking PET for a Walk — an Unusual Cause of Bilateral Leg Claudication JF - The Journal of Rheumatology JO - J Rheumatol SP - 877 LP - 879 DO - 10.3899/jrheum.090929 VL - 37 IS - 4 AU - TED YI-ENG TSAI AU - DAVID MASSASSO AU - PRANEAL SHARMA AU - JOHN CROZIER Y1 - 2010/04/01 UR - http://www.jrheum.org/content/37/4/877.abstract N2 - To the Editor:Large-vessel giant cell arteritis (LV-GCA) is a rare condition that is increasingly recognized with the advent of imaging techniques such as positron emission tomography (PET). However, the utility of PET in extracranial GCA is poorly defined and rarely reported, especially in lower-limb LV-GCA. We describe a case of GCA affecting the lower limbs in which PET, corroborated with computed tomography angiogram (CTA) and duplex ultrasound, was used to accurately assess and monitor the activity of this rare arteritis.A 59-year-old woman with minimal atherosclerotic risk factors presented with a 3-month history of progressive bilateral leg claudication. She initially noticed tightness in her right calf after walking 100 meters on level ground. The discomfort was proportional to exertion, and would promptly resolve with rest. There was similar, although less intense, discomfort in her left calf, and associated bilateral numbness in her middle 3 toes. Three months previously she had unlimited exercise tolerance on level ground. One month after the onset of claudication, her symptoms progressed to include bilateral thigh discomfort on exertion. There was no scalp tenderness, visual disturbance, jaw or tongue claudication, or polymyalgic or joint symptoms. She had lost 2.5 kilograms (4% total body weight) over 3 months.Her medical history was unremarkable. Her atherosclerotic risk factors included a brief 2.5 pack-year smoking history and a family history of lower-limb arterial disease (sister requiring femoropopliteal bypass at age 49 years) and old-age ischemic heart disease.On examination, the left popliteal artery and bilateral pedal pulses were absent. The right popliteal pulse was weakly palpable, and femoral pulses were present. There were no femoral, renal, or lower abdominal bruits. Temporal arteries were nontender, with normal pulses. There were no carotid, subclavian, or axillary artery bruits. Lower-limb neurological examination was normal.Initial blood tests showed a mildly elevated … Address correspondence to Dr. T. Tsai; e-mail: t.tsai{at}unsw.edu.au ER -