Case report

A 70-year-old woman was admitted to the hospital with a 3-year history of progressively reduced general health, vertigo, joint pain and exertional dyspnoea. Physical examination revealed a reduced general health status, a 3/6 systolic murmur at the aortic valve area, a dry cough and pitting oedema of both ankles. Abnormal laboratory parameters included an elevated C-reactive protein (71.7 mg/L; normal <5 mg/L) and hypochromic normocytic anaemia (haemoglobin 7.1 mmol/L, normal 7.6–9.5 mmol/L; mean corpuscular haemoglobin 1.59 fmol, normal 1.74–2.05 fmol). Echocardiography displayed pericardial effusion that was punctured, detecting granulocytes, macrophages and mesothelial cells in cytological analysis. Radiographs of the large joints showed diffuse symmetric osteoplastic changes. ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/CT (PET/CT) depicted infiltration of the thoraco-abdominal aorta, short occlusion of the left subclavian artery and stenosis of both renal arteries with slightly raised glucose metabolism in the corresponding vessels. Furthermore, symmetric raised bone metabolism of the long bones of the upper and lower extremities, numerous ribs, backbone, …