[Large vessel vasculitis as a cause of fever of unknown origin and increase of inflammatory markers]. / Vaskulitida velkých cév jako pricina horecky a zvýsení zánetlivých parametru.

In our practice, we encounter patients with fever and increase in inflammatory markers. The cause of their difficulties is often hard to discover. The investigation of such patients is described the importance of history, physical examination, laboratory tests and special examinations including imaging methods. After infectious aetiology is excluded, especially in cases of discrepancy between high C-reactive protein (CRP) levels and low procalcitonin levels, a systemic disease should be diagnosed in cooperation with rheumatologists. Positron emission tomography has proved useful for diagnosing large vessel vasculitis. The case report of a 60-year-old female is presented who had severe fatigue, neck pain, occasionally raised temperature and steadily increasing CRP levels. She was diagnosed with large vessel vasculitis. After treatment with immunosuppressive doses of corticosteroids her condition gradually improved. In the discussion, facts about diagnosis, pathophysiology and treatment of the disease are summarized.

Import of West Nile virus infection in the Czech Republic.

We report West Nile virus infection of the central nervous system in a 69-year-old man, residing in North Moravia (Czech Republic), who visited the USA from 6 July to 31 August 2002. He developed fever with fatigue at the end of his US stay, and was hospitalized in Ostrava after his return on 3 September with fever (up to 39.5 degrees Celsius), fatigue, anorexia, moderate laryngotracheitis, dizziness, insomnia, blurred speech, and a marked bradypsychism. EEG demonstrated a slow bifrontal theta-delta activity, and CT of the brain a slight hydrocephalus. A significant increase of antibodies neutralizing West Nile virus was detected between the first (1:16) and second (1:256) blood serum sample. The patient recovered gradually and was released from hospital on 16 September. This is the first recorded human case of West Nile fever (WNF) imported to the Czech Republic. Nine similar cases of WNF import from the USA have already been reported in other European countries - France, Denmark, the Netherlands, and Germany.