A 20-year-old female patient presented with fever for 2 months, associated with chills and rigors, evening raise of temperature and cough with expectoration. There was a history of vomitings for 10 days with the loss of appetite and weight loss. The patient did not respond to higher antibiotics for 7 days. Laboratory investigations revealed erythrocyte sedimentation rate (ESR) 100 mm/h, total leukocyte count was 5300 cells/cu mm, and C-reactive protein levels (CRP) >320 mg/L. Mantoux test and sputum for acid-fast bacillus (AFB) were negative. Antinuclear antibodies (ANA) were positive by indirect immunofluorescence test. Ultrasound abdomen revealed mild-to-moderate ascites and minimal left pleural effusion. Patient underwent 18F-FDG PET-CT for evaluation of fever of unknown origin.
On 18F-FDG PET-CT, maximum intensity projection (MIP) image revealed linearly increased tracer concentration in large vessels and multiple foci of increased FDG uptake in mediastinum and abdomen. Transaxial images showed increased FDG uptake in mediastinal lymph nodes, abdominal lymph nodes, wall of arch of aorta, thickened wall of ascending aorta, and pericardial effusion. Non-FDG avid left moderate pleural effusion and moderate ascites noted. Then, the patient was diagnosed to have disseminated extrapulmonary tuberculosis (TB) with aorto-arteritis. Treatment was started with antitubercular treatment (ATT) and low-dose steroids. Patient responded well and symptomatic improvement was seen after 3 months [Figure 1].