High-resolution color-coded ultrasonography findings of subacute temporal arteritis with ulcerating skin lesions.

Abstract

An 86-year-old man presented with double vision and bitemporal ulcerative secreting skin lesions that had developed over the preceding 3 weeks (Figure A). His medical history included a 3-month episode of new headache and jaw claudication, and a common cardiovascular risk profile (cerebral ischemic stroke 10 years previously, hypertension, atrial fibrillation, and vascular surgery involving the aorta and right carotid artery), as well. The patient denied experiencing fever or weight loss; his drug regimen included antihypertensive, anticoagulant (phenprocoumon), and topical corticosteroid agents. Clinical examination revealed mild anisocoria and pallhypesthesia, resulting in a slight impairment in gait, and a prominent, indurated, but painless left superficial temporal artery (STA), as well. High-resolution color duplex ultrasonography of the STA revealed an atypical echogenic endothelial layer and a periluminal hypoechogenic halo sign (Figure B and C). Extracranial ultrasonography identified moderate generalized arteriosclerosis. The erythrocyte sedimentation rate (ESR) was mildly elevated: 28 mm after 1 hour and 58 …