• Taku Harada, Yosuke Sasaki, Takahiro Tokunaga, Ayuha Yoshizawa, Sakiko Miura, Keiichiro Ikeda, Tsukasa Saito, and Juichi Hiroshige.
• Division of General Medicine, Showa University Koto Toyosu Hospital, Tokyo.
• Medicine (Baltimore). 2021 Mar 26; 100 (12): e25259e25259.

RationaleAlthough single organ vasculitis (SOV) is a rare occurrence and it is difficult to diagnose, its possibility as a cause of fever of unknown origin (FUO) must be considered. Recently, the usefulness of 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET/CT) in the diagnosis of unknown fevers due to vasculitis, especially in cases of small and medium-sized vasculitis, has begun to be pointed out.Patient ConcernsWe report the case of an 84-year-old woman with persisting fever for more than 2 weeks. She had no accompanying symptoms, other than fever, and the physical examination, echocardiography, and contrast-enhanced CT did not reveal any diagnostic clue.DiagnosesThe FDG PET/CT revealed positive uptakes of FDG in the left breast, with a standardized uptake value (SUV) of 2.9. The biopsy specimen of the left breast lesion revealed rupture of the elastic plate and evidence of fibrinoid necrosis of arteries, leading to the diagnosis of polyarteritis (PAN). Further angiographic examination and additional imaging did not reveal the presence of other lesions. Therefore, the diagnosis was established as a PAN-SOV of the left breast.InterventionsThis patient has improved with follow-up only.OutcomesThere has been no evidence of a relapse of PAN over a 5-year follow-up period.LessonsSOV presenting with unspecific local symptoms is difficult to diagnose based on the medical history and clinical examination. Our findings show that early "Combination of PET-CT and biopsy" can be a powerful diagnostic tool in patients with FUO for whom diagnosis of the underlying cause is difficult despite appropriate clinical examination.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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