Large-Vessel Giant Cell Arteritis Presenting as Back Pain with Vertebral Body Infarction in a 73-year-old Caucasian Woman

Abstract

To the Editor: Giant cell arteritis (GCA) is a chronic vasculitis that almost exclusively afflicts individuals age 50 years and older, with a prevalence of 1 in 500 individuals1,2. Early diagnosis is always the goal, so symptoms such as headache, scalp pain, jaw claudication, and amaurosis fugax should alert clinicians of the possibility of GCA and lead to early confirmatory biopsy3. GCA is also known to occasionally present in an unusual manner, which can cause significant confusion and ultimately delay the diagnosis, as was the case with our patient. A 73-year-old Caucasian woman with a history of lower back pain secondary to degenerative disc disease presented to the emergency department with a one-week history of incapacitating back and neck pain accompanied by stiffness. She described the pain as sharp, beginning in her mid-back, and then slowly progressing to both her lower cervical area and her upper sacrum. She could not find a position that was comfortable, and any movement made her symptoms much worse. She also complained of “shooting” pains in her forearms bilaterally, with transient numbness of her thumbs, as well as increasing stiffness in both shoulders. She specifically denied any jaw claudication, headaches, or visual disturbances. She had had a one-year history of lumbar degeneration for which she underwent a lumbar fusion of the L5 to S1 vertebrae 4 months prior to presentation. The medical history included known C4 through C6 spinal stenosis, a herpes zoster outbreak earlier that year, gastroesophageal reflux disease, mild interstitial pulmonary … Address correspondence to Dr. Maniaci; E-mail: maniaci.michael{at}mayo.edu