Giant Cell Arteritis Presenting Research Articles

A Case of Large Vessel Giant Cell Arteritis Presenting With Cough and Diagnosed Using an FDG-PET Scan

A Case of Large Vessel Giant Cell Arteritis Presenting With Cough and Diagnosed Using an FDG-PET Scan

It Is What It Is, Until It Isn't: An Unusual Presentation of Giant Cell Arteritis.

It Is What It Is, Until It Isn't: An Unusual Presentation of Giant Cell Arteritis.

Ophthalmic Artery Vessel Wall Inflammation in a Patient With Giant Cell Arteritis Presenting With Vision Loss: A Case Report.

Ophthalmic Artery Vessel Wall Inflammation in a Patient With Giant Cell Arteritis Presenting With Vision Loss: A Case Report.

Giant Cell Arteritis Presenting as Multiple Ischaemic Strokes: A Successful case of Endovascular Treatment.

Giant cell arteritis may manifest with aggressive and symptomatic intracranial arterial stenoses.Endovascular treatment is an effective intervention to prevent ischaemic complications in intracranial giant cell arteritis.

Case Report: Giant cell arteritis presenting as pyrexia of unknown origin

Giant cell arteritis, also known as temporal arteritis or cranial arteritis, is a type of systemic vasculitis that mainly affects large and medium-sized arteries in the head, neck, and upper extremities. It is characterized by inflammation of the walls of arteries, which can lead to narrowing or blockage of the affected vessels, and can result in serious complications such as vision loss, stroke and aortic aneurysm. The exact cause of giant cell arteritis is not fully understood, but it is believed to be an autoimmune disorder, where the immune system mistakenly attacks healthy cells and tissues in the body. Genetic, environmental and infectious factors may also play a role in its development. The disease is more common in people over 50 years of age and occurs more frequently in women than in men. Diagnosing this disease is challenging and requires high degree of clinical suspicion and use of advanced modalities for confirming the diagnosis. Here we report a case of a 70-year-old female with pyrexia of unknown of origin who was ultimately diagnosed as a case of giant cell arteritis by PET-CT.

Giant cell arteritis presenting with myocardial infarction.

Giant cell arteritis presenting with myocardial infarction.

E025 A complex case of giant cell arteritis presenting with visual loss, tongue and scalp infarction and multiple cranial neuropathies

Abstract Background/Aims Giant cell arteritis (GCA) is the most common of the vasculitides. Visual loss due to vascular occlusion is a well recognised complication of GCA. It is important to remember that other ischaemic complications can occur, leading to atypical clinical features. We present a case of a patient with GCA who did not complain of headaches, but presented with at least five cranial neuropathies, including a right optic neuropathy, ischaemic ulceration of her tongue and a large area of scalp necrosis. Methods We present the results of our patient case review and literature search. Results An 82-year-old retired landlady who was an ex-smoker presented with haemoptysis and was diagnosed with non-small-cell lung cancer. She was treated with chemotherapy and radiotherapy in 2020, then had possible disease progression on CT thorax in 2021. She developed thigh pain, swallowing difficulties and decreased oral intake in 2021, and subsequently developed severe oral ulceration, dehydration and delirium and was admitted to the frailty unit. On examination she had a very large scalp lesion, oral lesions, and multiple cranial neuropathies (right optic neuropathy, right partial third nerve, right seventh nerve, recurrent laryngeal, and bilateral twelfth nerve palsies). Her anterior ischemic optic neuropathy meant she could only see hand movements with the right eye. Blood tests revealed anaemia of chronic disease and a CRP of over 200 mg/L. Ultrasound scan of the temporal arteries showed a halo sign confirming the diagnosis of GCA. CT angiography showed vertebral artery wall thickening and stenosis. She was treated with intravenous methylprednisolone followed by high dose oral prednisolone, and started on methotrexate. She improved symptomatically. The cranial neuropathies resolved and the area of scalp necrosis and ischemic tongue ulceration healed, but vision was not regained. Her inflammatory markers never normalised and she was subsequently started on tocilizumab, with the approval of her oncologist. Her ESR and CRP quickly fell to normal. It remains to be seen how biologic treatment may impact her malignancy. Conclusion This case highlights multiple atypical presenting features of GCA and the need for a high index of suspicion to treat early and avoid irreversible visual loss. A review of the literature reveals that cranial neuropathies secondary to ischemia can be the presenting feature in GCA and multiple cranial neuropathies can occur. This is the first case in the literature, that we are aware of, which involves this number of cranial neuropathies alongside extensive scalp and tongue infarction. These features have all resolved with treatment, with the exception of unilateral permanent visual loss. Disclosure J. Jade: None. V. Barradell: None. A. Coote: None.

Aortic dissection secondary to giant cell arteritis.

British Journal of Hospital MedicineEarly view Case ReportAortic dissection secondary to giant cell arteritisConnor Cotton, Sarah Chatharoo, Pankaj ChaturvediConnor CottonCorrespondence to: Connor Cotton; E-mail Address: [email protected]Department of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UKSearch for more papers by this author, Sarah ChatharooDepartment of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UKSearch for more papers by this author, Pankaj ChaturvediDepartment of Diabetes and Endocrinology, Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Worksop, UKSearch for more papers by this authorConnor Cotton; Sarah Chatharoo; Pankaj ChaturvediPublished Online:17 Apr 2023https://doi.org/10.12968/hmed.2022.0529AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Agard C, Ponge T, Fradet G et al.. Giant cell arteritis presenting with aortic dissection: two cases and review of the literature. Scand J Rheumatol. 2006;35(3):233–236. https://doi.org/10.1080/03009740500395252 Crossref, Medline, Google Scholarde Boysson H, Espitia O, Samson M et al.. Giant cell arteritis-related aortic dissection: a multicenter retrospective study. Semin Arthritis Rheum. 2021;51(2):430–435. https://doi.org/10.1016/j.semarthrit.2021.03.001 Crossref, Medline, Google ScholarEvans JM, O'Fallon WM, Hunder GG. Increased incidence of aortic aneurysm and dissection in giant cell (temporal) arteritis: a population-based study. Ann Intern Med. 1995;122(7):502. https://doi.org/10.7326/0003-4819-122-7-199504010-00004 Crossref, Medline, Google ScholarHiratzka LF, Bakris GL, Beckman JA et al.. Faculty opinions recommendation of 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/sir/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121(13): e266–369. https://doi.org/10.1161/CIR.0b013e3181d4739e Medline, Google ScholarKermani TA, Warrington KJ, Crowson CS et al.. Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis. Ann Rheum Dis. 2013;72(12):1989–1994. https://doi.org/10.1136/annrheumdis-2012-202408 Crossref, Medline, Google ScholarMackie SL, Dejaco C, Appenzeller C et al.. British society for rheumatology guideline on diagnosis and treatment of giant cell arteritis. Rheumatology. 2020;59(3):e01–e23. https://doi.org/10.1093/rheumatology/kez672 Crossref, Medline, Google ScholarNayar AK, Casciello M, Slim JN, Slim AM. Fatal aortic dissection in a patient with giant cell arteritis: a case report and review of the literature. Case Rep Vasc Med. 2013;2013:1–4. https://doi.org/10.1155/2013/590721 Google Scholar FiguresReferencesRelatedDetails Ahead of PrintISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 17 April 2023 Information© MA Healthcare LimitedAcknowledgementsThe authors would like to thank Sarah Gardner, Library and Information Service, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust Knowledge, Doncaster, for her help with the literature search.PDF download

Baseline Characteristics and Clinical Presentation of Biopsy-Proven Giant Cell Arteritis in White Compared with Black Patients.

Giant cell arteritis (GCA) is the most prevalent systemic vasculitis in the elderly and can lead to permanent vision loss if left untreated. Most earlier studies have evaluated GCA in primarily white populations, and GCA was traditionally thought to occur at nearly negligible frequency in black populations. Our previous study showed that GCA may occur at similar rates in white and black patients, but little is known about the presentation of GCA in black patients. The purpose of this study is to examine baseline presentation of biopsy-proven GCA (BP-GCA) in a tertiary care center-based population with a sizeable proportion of black patients. Retrospective study from a single academic institution of a previously described cohort of BP-GCA. Presenting symptoms, laboratory findings, and GCA Calculator Risk score were compared in black and white patients with BP-GCA. Among 85 patients with biopsy-proven GCA, 71 (84%) were white and 12 (14%) were black. White patients had higher rates of elevated platelet count (34% vs 0%, P = 0.04), whereas black patients had higher rates of diabetes mellitus (67% vs 12%, P < 0.001). There were no statistically significant differences in age, gender, biopsy classification (active vs healed arteritis), cranial symptoms, visual symptoms/ophthalmic findings, rates of abnormal erythrocyte sedimentation rate or C-reactive protein, unintentional weight loss, polymyalgia rheumatica, or GCA risk calculator score. Presenting features of GCA were similar between white and black patients in our cohort, except for rates of abnormal platelet level and diabetes. Physicians should feel comfortable relying on the usual clinical features for the diagnosis of GCA independent of race.

Giant Cell Arteritis Presenting With Isolated Cotton Wool Spots: A Case Report

Giant Cell Arteritis Presenting With Isolated Cotton Wool Spots: A Case Report

Presentation, diagnosis and treatment of giant cell arteritis

Objective: To present patients with giant cell arteritis (GCA) in our centre over a 10 year period in order to confirm current understanding of giant cell arteritis (GCA) and observe any possible specifities in our cohort. Patients and Methods: In this retrospective study all patients diagnosed with GCA in the Clinical Hospital Centre Rijeka from 1 Jan 2011 to 31 Dec 2021 were included. Data were collected on disease presentation and diagnostic workup at the initial exam, and treatment. Results: A total of 51 patients were included in the study, of which 72.55% patients were female, and 72.55% were over 70. Of 50 patients with available data in medical documentation, 8 (16.00%) had systemic disease (S-GCA), while the rest had cranial disease (C-GCA). Headache, considered also a pathognomonic sign, was the most common initial symptom (88.00% in whole cohort, or 97.62% if S-GCA is excluded). Of 49 patients, all had increased erthyrocyte sedimentation rate. Temporal artery biopsy was positive in 12/16 patients with C-GCA, while temporal artery ultrasound was positive in 12/16 patients. Biopsy or ultrasound was not performed in 18 patients, of which 8 were patients with S-GCA, and data were not available for one patient. No patients had both a biopsy and ultrasound performed. All patients were treated with glucocorticoids, 9.80% were also treated with methotrexate, 7.84% with toclizumab, and one with both methotrexate and azathioprine. Conclusion: These results are comparable to other centres in Croatia and at least one centre abroad.

Giant cell arteritis presenting with chronic cough and headache after BNT162b2 mRNA COVID-19 vaccination.

Giant cell arteritis presenting with chronic cough and headache after BNT162b2 mRNA COVID-19 vaccination.

Case Report: Giant Cell Arteritis presenting with 6th Nerve Palsy without Ischemic Optic Neuropathy

Purpose: Giant cell arteritis (GCA) can be a difficult condition to identify in the early stages especially in the absence of the pathognomonic arteritic anterior ischemic optic neuropathy. Optometrists serve an important role in correctly triaging and initiating appropriate work-up and treatment for this emergent condition. This case report and review serves as a refresher of the systemic and ocular signs and symptoms of GCA. Background: GCA is a systemic autoimmune condition characterized by granulomatous inflammation of medium and large arteries in patients over 50. The most well-known constellation of signs and symptoms include new onset headache, jaw claudication, scalp tenderness, temporal artery abnormality with painless vision loss secondary to arteritic anterior ischemic optic neuropathy. However, it is important to be aware of alternate presenting signs and symptoms including pain anywhere in the distribution of the external carotid (occipital, neck, tongue, throat, ear) and signs of large vessel GCA (arm/limb claudication, chest/back pain, Raynaud’s phenomenon) and Polymyalgia Rheumatica (PMR) (bilateral hip/shoulder pain and morning stiffness). Case Report: An 86-year-old Caucasian female presents for a referred exam regarding new onset diplopia with concurrent occipital headache, neck pain and sore throat originally dismissed as symptoms of her other systemic health conditions. ESR, CRP and platelets were elevated on serology and subsequent temporal artery biopsy was positive for GCA. Oral steroids were initiated, and she was lost to follow up after her ocular symptoms resolved. Conclusion: GCA can present with a large range of manifestations, and many are nonspecific and easily attributable to other causes especially when it deviates from the classic constellation of new onset headache, jaw claudication, scalp tenderness and temporal artery abnormality with painless vision loss. Optometrists as primary eye care providers may be the first point of contact and need to be cognizant of the broader set of manifestations to minimize delays in diagnosis and treatment of this life and vision threatening condition. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/case-report-giant-cell-arteritis-presenting-with-6th-nerve-palsy-without-ischemic-optic-neuropathy) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series.

PurposeTo evaluate demographic and clinical characteristics of a Chinese population with giant cell arteritis using multimodal imaging focusing on ophthalmic examinations.DesignRetrospective observational case series.Materials and MethodsIn the neuro-ophthalmology division of the Eye, Ear, Nose, and Throat Hospital, Shanghai, we evaluated the demographic and clinical characteristics of patients diagnosed with giant cell arteritis between January 2016 and June 2021. Results of routine ophthalmic examinations including fundus examination, optical coherence tomography, color duplex ultrasonography of ocular and superficial temporal arteries, orbital magnetic resonance imaging, and superficial temporal artery biopsy were evaluated.ResultsA total of 15 patients (22 eyes; ten male and five female) were evaluated with a mean age of 77.0 ± 8.5 years. Among them, seven had bilateral involvement that occurred simultaneously or sequentially. Twelve patients presented with arteritic anterior ischemic optic neuropathy, two with arteritic anterior ischemic optic neuropathy combined with cilioretinal artery occlusion, and one with cotton-wool spots. In acute stages of optic neuropathy and retinopathy, optical coherence tomography revealed optic disc edema, thickening of the inner retinal nerve fiber layer and ganglion cell layer, and loss of layer structure. In late stages, optical coherence tomography revealed diffuse atrophy of the inner retina. The “halo” sign was observed in 12 patients in the superficial temporal artery ultrasound, and seven out of eight patients who underwent biopsy demonstrated classic giant cell arteritis pathological changes. Most patients having poor visual acuity but ability to perceive light; 10/22 eyes had permanent vision loss.ConclusionAlthough rare in Asians, giant cell arteritis may be underdiagnosed among elderly Chinese patients presenting with anterior ischemic optic neuropathy. Non-invasive superficial temporal artery ultrasound detecting inflammatory thickening of the intima as the “halo” sign combined with routine elevated erythrocyte sedimentation rate and C-reactive protein may be helpful in diagnosing patients with a high probability of having giant cell arteritis.

Central retinal vein oclussion as presentation of giant cell arteritis and polymyalgia rheumatica. Case report

The coexistence between Giant Cell Arteritis and Polymyalgia Rheumatica, as well as the development of extra-articular symptoms are not uncommon, predominantly arterial vascular affection at the ocular level is one of the main ones; however, ocular venous involvement in the absence of other factors is a rare and poorly described complication. We present the case of a patient who presents with a central retinal thrombosis, attributed to the rheumatic inflammatory component, with an unfavorable evolutionary prognosis.

Giant cell arteritis presenting with progressive dysphagia and tongue necrosis.

A 72-year-old man was admitted to hospital with 1 month of progressive solid food dysphagia that caused a 10-kg weight loss. The patient reported alcohol and tobacco use but had no known medical conditions. An oral examination and head and neck computed tomography (CT) were normal apart from poor

Complex oculomotor nerves palsy and incidental ischemic stroke as atypical presentation of giant cell arteritis

Complex oculomotor nerves palsy and incidental ischemic stroke as atypical presentation of giant cell arteritis

Giant cell arteritis involving the facial artery – A case report of an unusual presentation

Giant cell arteritis is a large vessel vasculitis. It involves the superficial temporal artery in 100% of cases.1 It has been known to involve other arteries with varying manifestations. Only a few case reports of giant cell arteritis involving the facial arteries are available. Cranial manifestations of giant cell arteritis such as jaw claudication, facial swelling, dental pain and unusually overt necrosis of the tongue are the result of involvement of branches of external carotid artery, including the facial artery.2 However, to the best of our knowledge, jaw swelling as an initial presentation of giant cell arteritis has been reported only infrequently.2 We present the case of a 71-year-old male with giant cell arteritis involving the facial artery who presented with jaw swelling as the initial presentation.

Various etiologies and presentations of giant cell arteritis: A series of case reports

GCA is a granulomatous vasculitis of unknown origin and targets large vessels with predominance for the aortic arch and the cranial branches. The underlying etiology of GCA is complex and has been widely researched, yet is still not well understood. The average age of presentation is 72.5 years for women and 70.3 years old for men. Furthermore, women are affected between 2 and 6 times more often than men. With vision loss, ophthalmologists are on the front lines of diagnosing the disorder. In addition to vision loss, patients commonly note associated symptoms such as headache, jaw claudication, diplopia, myalgias, and constitutional symptoms. The most commonly feared sequel of GCA is permanent visual loss secondary to arteritic anterior ischemic optic neuropathy (AAION). Here we present a series of case reports of GCA with their various presentations.

Presumed Giant Cell Arteritis presenting as Sequential Bilateral 6th Nerve Palsies: Case Report and Review of Literature

Giant CELL ARTERITIS (GCA) is a systemic autoimmune disease that classically presents with jaw claudication, temporal headache and transient visual loss, affecting mostly people above the age of 50 years. However, diplopia due to cranial nerve 6 palsy (CN VI) has been rarely reported in GCA. Moreover, bilateral CN VI palsies, occurring in a sequential fashion in GCA is exceedingly rare. We report a case of a 70-year-old man who was admitted to our hospital twice within the span of one month with persistent binocular diplopia due to sequential, bilateral, CN VI palsies (right followed by left CN VI palsy) with associated eye pain, temporal headache, malaise and joint pain. The inflammatory markers including Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) were elevated at both admissions. He was treated with intravenous steroids with a complete resolution of his binocular diplopia, eye pain and temporal headache. Despite a negative biopsy of the temporal artery for evidence of inflammation, he was diagnosed with GCA by rheumatology, considering the fact that GCA pathology may have a patchy distribution, and a negative biopsy does not rule it out absolutely. This case underscores the importance of recognizing GCA as a differential diagnosis in patients presenting with binocular diplopia.