Abdominal Pain in a Patient With Giant Cell Arteritis

Giant cell arteritis (GCA) is a large vessel vasculitis seen in the elderly. It is primarily treated with corticosteroids, which are known to have a multitude of adverse effects, including predisposition to infection and intestinal diverticular perforation. We describe a unique case of a GCA patient with the subtle presentation of acute abdomen. A 71-year-old woman with GCA on corticosteroids presented with vague abdominal pain at a routine follow-up appointment. Diagnostic workup revealed perforated diverticulitis and urinary tract infection. She was admitted and managed conservatively. Clinicians may encounter similar scenarios to ours in which GCA patients will present with subtle symptoms of an acute abdomen. Corticosteroids mask symptoms in the setting of severe complications, especially in elderly patients. We recommend providers have a high index of suspicion for an acute condition, even when the clinical manifestations are subtle.