Giant cell arteritis presenting as tongue necrosis

Abstract

Giant cell arteritis (GCA) is a large and medium-vessel systemic vasculitis affecting predominantly the internal and external carotid arteries with particular affinity for its extra-cranial branches (especially, the superficial temporal artery). The most frequent complication of this disorder is visual loss. We report the case of a patient who suffered tongue necrosis (a rare complication) secondary to giant cell arteritis. Case Report: A 71-year-old female who after having her dentures refitted developed severe pain, edema of the tongue, odynophagia, dysphagia and resultant anorexia. She was admitted with the diagnosis of glossitis and initially treated with antifungals and later antiviral medications without improvement. She subsequently developed tongue ulcerations, severe pain in temporomandibular joint (TMJ) with right sided headache. Temporal arteritis was suspected at this point, re-examination revealed palpable and tender temporal arteries (R>L). Tongue examination demonstrated dark greyish plaques in the dorsum with areas of ulceration without palatal involvement. An elevated ESR and the right sided temporal artery biopsy that followed demonstrating chronic inflammation with the presence of giant cells confirmed the diagnosis of GCA. Treatment with oral prednisone (1 mg/kg/day) produced a rapid improvement of her symptoms and ulcers with complete resolution at three months. Conclusion: The presence of glossitis in GCA represents a severity marker of this disease and is associated with a higher risk of vision loss and mortality. As such a high level of suspicion is necessary for the early recognition of this rare presentation and prompt institution of treatment to prevent the aforementioned complications.