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Case Reports
. 2025 Jun 16;17(6):e86134.
doi: 10.7759/cureus.86134. eCollection 2025 Jun.

Giant Cell Arteritis Presenting As Pyrexia of Unknown Origin: Diagnosis Made by Bilateral Periluminal Dark Halo Sign on Color Doppler Ultrasound

Rehan Siddique  1 , Sally Alezergawi  1 , Aminah Patel  1 , Amber Khan  1
Affiliations
Case Reports

Giant Cell Arteritis Presenting As Pyrexia of Unknown Origin: Diagnosis Made by Bilateral Periluminal Dark Halo Sign on Color Doppler Ultrasound

Rehan Siddique et al. Cureus. .

Abstract

Giant cell arteritis (GCA), a vasculitis of medium- and large-sized arteries, frequently manifests with symptoms such as headaches, soreness in the scalp, and vision abnormalities. Pyrexia is an uncommon symptom and can cause a delay in diagnosis. We describe a 76-year-old woman of Chinese ethnicity who did not exhibit the typical clinical signs of GCA but instead presented with a generalized lethargy, nausea, dizziness, and a persistent fever. Numerous tests, including autoimmune, neoplastic, and viral workups, came up negative. Pyrexia did not settle despite using broad-spectrum antibiotics. A temporal artery Doppler ultrasound was performed to assess the condition further, as inflammatory markers (erythrocyte sedimentation rate, ESR, and C-reactive protein) remained high. The ultrasound Doppler results showed bilateral halo signs that are very specific for GCA. Upon starting corticosteroid treatment, there was a rapid improvement in fever and ESR. This case underscores the importance of considering GCA as a differential diagnosis for pyrexia of unknown origin, particularly in the elderly. It highlights the utility of temporal artery ultrasound in facilitating timely diagnosis in atypical cases.

Keywords: giant cell arteritis; halo sign; pyrexia of unknown origin; temporal artery ultrasound; vasculitis.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Temporal artery color Doppler ultrasound (right STA)
Ultrasound images show a dark hypoechoic halo around the right STA lumen (arrows), representing the vessel wall inflammation STA: superficial temporal artery
Figure 2
Figure 2. Temporal artery color Doppler ultrasound (right parietal branch)
Ultrasound image showing marked hypoechoic "halo sign" (arrows) and circumferential wall thickening
Figure 3
Figure 3. The right frontal branch US Doppler
Positive compression sign, the hypoechoic area persists (arrow) during the compression maneuver of the vessel lumen US: ultrasound
Figure 4
Figure 4. The left STA US Doppler
Left STA showing circumferential hypoechoic wall thickening and periluminal dark "halo sign" (arrows) STA: superficial temporal artery; US: ultrasound
Figure 5
Figure 5. The left parietal branch US Doppler
There is sonographic evidence of a dark periluminal halo sign (arrows), highly suggestive of giant cell arteritis US: ultrasound
Figure 6
Figure 6. Trend of temperature throughout admission
See this image and copyright information in PMC

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