A case of giant cell arteritis and polymyalgia rheumatica misdiagnosed as temporomandibular dysfunction

Abstract

We report the case of a 83-year-old man who presented with bilateral scalp ulcerations, temporomandibular joint pain, anorexia, and generalized discomfort. The aspecific presentation and timing of the symptoms led to a referral delay of 117 days. A temporal artery biopsy confirmed the diagnosis of giant cell arteritis (GCA). FDG-PET showed increased uptake at the large vessels, shoulders, and hips, suggesting concomitant polymyalgia rheumatica. Initiation of methylprednisolone resulted in resolution of the muscle-related complaints and healing of the ulcerations. This report highlights the importance of prompt diagnosis and the rarity of bilateral scalp necrosis in GCA, with an incidence of <5%.