COD 194 - 2 Years, All 3 Vessel Sizes, One Diagnosis

A 37-year-old man was treated for Lemierre's syndrome, then TB, then presumed ANCA-associated vasculitis. Every label turned out to be wrong.

Over 2 years, his disease moved through large, medium, and small vessels — carotid and subclavian arteritis, aortitis with SMA and celiac involvement, and waxing-waning lung lesions that behaved exactly like ANCA-associated vasculitis but with persistently negative serology. The final diagnosis only became clear after multiple findings had manifested in space and time.

This case walks through the full imaging timeline from Oct 2023 to Jan 2026, the missteps along the way, and the clinical clues that finally pointed to the answer.