Listen to the axillary artery: diagnosis of occult giant cell arteritis.

Large-vessel involvement is increasingly recognized in giant cell arteritis (GCA) and frequently occurs with an unspecific systemic inflammatory syndrome or fever of unknown origin. We describe the case of a 68-year-old woman with a history of polymyalgia rheumatica who presented with progressive weight loss, unexplained anemia, and a marked humoral inflammatory response. Diagnosis of large-vessel GCA was facilitated by axillary artery auscultation, revealing a bilateral axillary artery bruit. The diagnosis was confirmed by color duplex sonography and temporal artery biopsy. In elderly patients with an unspecific systemic inflammatory condition, axillary artery auscultation is a simple but valuable tool for detection of underlying occult large-vessel GCA.

Multiglandular hormone deficiency in a patient with systemic capillary leak syndrome.

Systemic capillary leak syndrome (SCLS) is a rare but potentially fatal disorder characterized by a loss of fluid and proteins into the interstitial space leading to intravascular hypovolemia up to the point of hypovolemic shock. We report the case of a 64-year-old man with SCLS and multiple hormone abnormalities (primary hypothyroidism, hypoadrenalism, and hypogonadism), deficiency of hormone binding globulins, and hypogammaglobulinemia. The patient was successfully treated with intravenous immunoglobulins, theophylline, and terbutaline. Strikingly, with the dissolution of peripheral edema, hormone levels improved. To our knowledge, this is the first reported case of SCLS associated with polyglandular abnormalities.