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An Unusual Case of Giant Cell Arteritis

Giant cell arteritis (GCA), also known as temporal arteritis (TA), is a systemic autoimmune inflammation of medium and large arteries. It is the most common vasculitis affecting adults older than 50, with an incidence of 20/100,000 and an average age of onset of 70. Typically, patients initially pre...

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Autores principales: Goyal, Nitasha, Basnet, Arjun, Donenfeld, Thai T, Tiwari, Kripa, Clemen, Britney M, Kyaw, Htin, Nwosu, Ifeanyi, Ibeson, Emeka C, Konka, Sarita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9339147/
https://www.ncbi.nlm.nih.gov/pubmed/35919218
http://dx.doi.org/10.7759/cureus.26483
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author Goyal, Nitasha
Basnet, Arjun
Donenfeld, Thai T
Tiwari, Kripa
Clemen, Britney M
Kyaw, Htin
Nwosu, Ifeanyi
Ibeson, Emeka C
Konka, Sarita
author_facet Goyal, Nitasha
Basnet, Arjun
Donenfeld, Thai T
Tiwari, Kripa
Clemen, Britney M
Kyaw, Htin
Nwosu, Ifeanyi
Ibeson, Emeka C
Konka, Sarita
author_sort Goyal, Nitasha
collection PubMed
description Giant cell arteritis (GCA), also known as temporal arteritis (TA), is a systemic autoimmune inflammation of medium and large arteries. It is the most common vasculitis affecting adults older than 50, with an incidence of 20/100,000 and an average age of onset of 70. Typically, patients initially present with new-onset headaches, visual changes and disturbances, jaw claudication, arthralgias, and tender or swollen temporal or occipital arteries. Our patient is a 73-year-old male who presented to the emergency room with 10 days of bilateral headache radiating to the occipital area associated with fevers, persistent chills, generalized weakness, and a headache described as constant, dull, 9 out of 10 pain, and minor pain with neck flexion. Lab work revealed an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The patient had tender palpation to his temples and due to a high suspicion of giant cell arteritis, he was started on high-dose steroids with rapid relief of his symptoms. Biopsy showed evidence of active non-granulomatous vasculitis and confirmed bilateral temporal arteritis within the context of the clinical setting. GCA patients are more likely to be women and typically present with unilateral headache (66% of GCA), jaw claudication (50%), fevers (50%), and transient visual loss (16-54%). Here, we describe a 73-year-old male with a past medical history of cerebral vascular accident (CVA), diabetes, and cancer that presented with 10 days of bilateral headaches and fevers. Unlike the usual presentation, our patient denied any vision and joint pain changes, and the temporal arteries were not stiff to palpation. This patient presentation is unique to previous reports in the limited display of symptoms and absence of the most commonly associated manifestations. Although his presentation supported GCA, the features of elevated ESR and CRP, headache, and fever were too general to diagnose GCA exclusively, and his additional symptoms of rhinorrhea and sinus pain more likely supported infection. Our case indicates the importance of maintaining a high index of clinical suspicion for GCA in the elderly population presenting with headaches and elevated ESR and CRP. GCA, also known as temporal arteritis (TA), is a systemic autoimmune inflammation of medium and large arteries. Typically, patients initially present with new-onset headaches, visual changes and disturbances, jaw claudication, arthralgias, and tender or swollen temporal or occipital arteries. Diagnosis requires high clinical suspicion, and treatment revolves around high doses of steroids.
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spelling pubmed-93391472022-08-01 An Unusual Case of Giant Cell Arteritis Goyal, Nitasha Basnet, Arjun Donenfeld, Thai T Tiwari, Kripa Clemen, Britney M Kyaw, Htin Nwosu, Ifeanyi Ibeson, Emeka C Konka, Sarita Cureus Internal Medicine Giant cell arteritis (GCA), also known as temporal arteritis (TA), is a systemic autoimmune inflammation of medium and large arteries. It is the most common vasculitis affecting adults older than 50, with an incidence of 20/100,000 and an average age of onset of 70. Typically, patients initially present with new-onset headaches, visual changes and disturbances, jaw claudication, arthralgias, and tender or swollen temporal or occipital arteries. Our patient is a 73-year-old male who presented to the emergency room with 10 days of bilateral headache radiating to the occipital area associated with fevers, persistent chills, generalized weakness, and a headache described as constant, dull, 9 out of 10 pain, and minor pain with neck flexion. Lab work revealed an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The patient had tender palpation to his temples and due to a high suspicion of giant cell arteritis, he was started on high-dose steroids with rapid relief of his symptoms. Biopsy showed evidence of active non-granulomatous vasculitis and confirmed bilateral temporal arteritis within the context of the clinical setting. GCA patients are more likely to be women and typically present with unilateral headache (66% of GCA), jaw claudication (50%), fevers (50%), and transient visual loss (16-54%). Here, we describe a 73-year-old male with a past medical history of cerebral vascular accident (CVA), diabetes, and cancer that presented with 10 days of bilateral headaches and fevers. Unlike the usual presentation, our patient denied any vision and joint pain changes, and the temporal arteries were not stiff to palpation. This patient presentation is unique to previous reports in the limited display of symptoms and absence of the most commonly associated manifestations. Although his presentation supported GCA, the features of elevated ESR and CRP, headache, and fever were too general to diagnose GCA exclusively, and his additional symptoms of rhinorrhea and sinus pain more likely supported infection. Our case indicates the importance of maintaining a high index of clinical suspicion for GCA in the elderly population presenting with headaches and elevated ESR and CRP. GCA, also known as temporal arteritis (TA), is a systemic autoimmune inflammation of medium and large arteries. Typically, patients initially present with new-onset headaches, visual changes and disturbances, jaw claudication, arthralgias, and tender or swollen temporal or occipital arteries. Diagnosis requires high clinical suspicion, and treatment revolves around high doses of steroids. Cureus 2022-07-01 /pmc/articles/PMC9339147/ /pubmed/35919218 http://dx.doi.org/10.7759/cureus.26483 Text en Copyright © 2022, Goyal et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Goyal, Nitasha
Basnet, Arjun
Donenfeld, Thai T
Tiwari, Kripa
Clemen, Britney M
Kyaw, Htin
Nwosu, Ifeanyi
Ibeson, Emeka C
Konka, Sarita
An Unusual Case of Giant Cell Arteritis
title An Unusual Case of Giant Cell Arteritis
title_full An Unusual Case of Giant Cell Arteritis
title_fullStr An Unusual Case of Giant Cell Arteritis
title_full_unstemmed An Unusual Case of Giant Cell Arteritis
title_short An Unusual Case of Giant Cell Arteritis
title_sort unusual case of giant cell arteritis
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9339147/
https://www.ncbi.nlm.nih.gov/pubmed/35919218
http://dx.doi.org/10.7759/cureus.26483
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