Unilateral Primary Carotiditis: A Case Report

Abstract

We report the first case of isolated unilateral carotid arteritis, following an upper respiratory tract infection in a patient without other medical conditions. We collected clinical information during the patient’s hospitalization and follow-up. Through a Pubmed search, we identified articles discussing TIPIC syndrome, carotid pain, or inflammation. After reviewing the articles and the corresponding images, none of these reported clinical and radiological findings similar to ours. A 55-year-old man consulted for unilateral neck pain, without relevant clinical history apart from an upper respiratory tract infection, nor other signs or symptoms. An MRI before admission showed signs of focal adventitial inflammation of the left internal carotid artery. Ultrasound identified a mixed plaque with hypoechoic and isoechoic components at the beginning of the left internal carotid. In particular, there was no halo sign suggestive of giant cell arteritis. Extensive laboratory exams only found increased plasma IL-1 receptor antagonist. After three days of corticosteroid and acetylsalicylic acid treatment., cervicalgia completely regressed, and prednisone was stopped. The patient was discharged on day 7 on daily acetylsalicylic acid. At three months, he remained asymptomatic, carotid ultrasound was comparable to the first one, and treatment was stopped. We suggest that a purely vascular inflammation of the carotid could appropriately be defined “carotiditis”, considering the focal, isolated involvement of the carotid wall, and that such a unilateral presentation has never been reported before. Speculatively, we propose an association between carotidis and the upper respiratory tract infection in this patient.