Giant Cell Arteritis: An Atypical Presentation Diagnosed with the Use of MRI Imaging.

Siddesh Shambhu,Lisbet Suarez

doi:10.1155/2016/8239549

Siddesh Shambhu, Lisbet Suarez

Open Access

https://doi.org/10.1155/2016/8239549

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Abstract

Giant cell arteritis (GCA) is the most common primary systemic vasculitis in western countries in individuals over the age of 50. It is typically characterised by the granulomatous involvement of large and medium sized blood vessels branching of the aorta with particular tendencies for involving the extracranial branches of the carotid artery. Generally the diagnosis is straightforward when characteristic symptoms such as headache, jaw claudication, or other ischemic complications are present. Atypical presentations of GCA without “overt” cranial ischemic manifestations have become increasingly recognised but we report for the first time a case of GCA presenting as mild upper abdominal pain and generalized weakness in the context of hyponatremia as the presenting manifestation of vasculitis that was subsequently diagnosed by MRI scanning. This case adds to the literature and emphasises the importance of MRI in the evaluation of GCA patients without “classic” cranial ischemic symptoms.

Highlights

Giant cell arteritis is a chronic autoimmune vasculitis characterised by the infiltration of medium and large vessels by monocyte-derived giant cells leading to local and systemic inflammation
We present the case of a 79-year-old male who presented with generalized weakness and hyponatremia later revealed to be secondary to underlying Giant cell arteritis (GCA)
A 79-year-old retired man with a past medical history of atrial fibrillation, cerebrovascular accident, hypertension, hypothyroidism, and myocardial Infarction presented to the hospital with a one-week history of generalized weakness and hyponatremia on routine blood work that had recently been ordered by his primary care physician

Summary

Introduction

Giant cell arteritis is a chronic autoimmune vasculitis characterised by the infiltration of medium and large vessels by monocyte-derived giant cells leading to local and systemic inflammation. It is defined as a panarteritis that preferentially involves the extracranial branches of the carotid artery [1]. It has an estimated incidence of 20 cases per 1000 individuals and prevalence of 1 in 500 individuals [2]. To be deemed as having GCA, patients must meet 3 of the following 5 criteria: (1) age over 50; (2) new-onset localized headache; (3) temporal artery tenderness or reduced pulse; (4) ESR of 50 mm/h or higher; (5) abnormal temporal artery biopsy findings demonstrating mononuclear infiltration or granulomatous inflammation [4]. We present the case of a 79-year-old male who presented with generalized weakness and hyponatremia later revealed to be secondary to underlying GCA

Case Report

Findings

Discussion