An Enigmatic Case of Giant Cell Arteritis

Fatigue is commonly encountered in clinical settings with a myriad of possible etiologies that can range from benign to life-threatening illnesses.In this report, we discuss a case of a 60-year-old female with a history of B12 deficiency, hypertension, and treated hepatitis C who presented with persistent fatigue, diffuse myalgias, night sweats, and reduced appetite.Her initial workup revealed a low-grade fever (101.9F), slightly elevated erythrocyte sedimentation rate (ESR, 29 mm/hr) and C-Reactive Protein (CRP, 7.6 mg/L).Labs and imaging were otherwise unremarkable.At follow-up, her symptoms persisted, and new-onset shortness of breath was noted.Transthoracic Echocardiography (TTE) showed moderate pericardial effusion with no tamponade, and whole body PET-CT showed avid aortitis and first order vessel vasculitis.The patient was diagnosed with giant cell arteritis (GCA) and began treatment with prednisone and tocilizumab.The pharmacologic treatment led to symptom improvement and reduced pericardial effusion.This case illustrates the diagnostic challenges associated with nonspecific symptoms like fatigue, especially when inflammatory markers are only mildly elevated.While ESR and CRP are widely utilized to evaluate for inflammatory conditions, they lack specificity and may be misleading in atypical presentations of GCA.We aim to detail the diagnostic workup for fatigue, emphasizing the role that inflammatory markers may have.Understanding the correlation between inflammatory processes and chronic fatigue can aid in accurate diagnosis, tailored treatment strategies, and improved long-term outcomes for patients.