Zoledronate-Induced Large Vessel Vasculitis Diagnosed by PET/CT

Bisphosphonates remain a first-line treatment for osteoporosis. The most-widely used is zoledronate, which is well tolerated by most patients, but may rarely cause acute inflammatory reactions, which resemble those of large vessel vasculitis (LVV). We report a third case of LVV associated with zoledronic acid infusion, presenting with a 2-week history of fever up to 40 °C, flu-like symptoms, left jaw pain, myalgia, arthralgia, ankle stiffness in the morning, and intermittent claudication, diagnosed by the hybrid imaging modality 18F-FDG PET/CT with isolated lower extremity involvement and successfully treated with glucocorticoids.