Rare Ischemic Complications of Giant Cell Arteritis: Case Series and Literature Review

Overview

Journal Am J Case Rep

Specialty General Medicine

Date 2022 Oct 14

PMID 36240129

Authors

Darya S Jalaledin

Carolyn Ross

Jean-Paul Makhzoum

Affiliations

Soon will be listed here.

Abstract

BACKGROUND Some ischemic complications due to giant cell arteritis (GCA) are rare and underdiagnosed. We describe the clinical features and outcomes of patients with GCA presenting with rare ischemic complications. CASE REPORT Our single-center retrospective database of patients with GCA was reviewed from 1994 to 2020. We describe 3 cases of rare ischemic complications secondary to GCA. We review the literature regarding ischemic complications due to GCA and their outcomes. All 3 cases met the American College of Rheumatology criteria for GCA. All patients experienced rare ischemic complications due to GCA. In case 1, the patient presented with a sixth cranial nerve palsy. In case 2, the patient presented with tongue and scalp necrosis, and with permanent visual loss due to anterior ischemic optic neuropathy. In case 3, the patient presented with scalp necrosis. In all 3 cases, the patients received glucocorticoids either intravenously and/or orally, which led to improvement. They all improved within the course of their followup visits. A literature review was performed to identify similar cases and outcomes. CONCLUSIONS Ischemic complications due to GCA can be part of the initial presentation of the vasculitis, making confirmation of the diagnosis more difficult. Physicians should be aware of these rare complications since rapid diagnosis and initiation of glucocorticoids may alter the course of the disease.

Citing Articles

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References

Martinez-Taboada V, Lopez-Hoyos M, Narvaez J, Munoz-Cacho P . Effect of antiplatelet/anticoagulant therapy on severe ischemic complications in patients with giant cell arteritis: a cumulative meta-analysis. Autoimmun Rev. 2014; 13(8):788-94. DOI: 10.1016/j.autrev.2014.02.006. View

Blockmans D . Fluorodeoxyglucose Positron Emission Tomography for Giant Cell Arteritis. J Rheumatol. 2017; 44(12):1763-1764. DOI: 10.3899/jrheum.170966. View

Kermani T, Matteson E, Hunder G, Warrington K . Symptomatic lower extremity vasculitis in giant cell arteritis: a case series. J Rheumatol. 2009; 36(10):2277-83. DOI: 10.3899/jrheum.090269. View

DeBord L, Chiu I, Liou N . Delayed Diagnosis of Giant Cell Arteritis in the Setting of Isolated Lingual Necrosis. Clin Med Insights Case Rep. 2019; 12:1179547619857690. PMC: 6587389. DOI: 10.1177/1179547619857690. View

Calvo-Romero J . Giant cell arteritis. Postgrad Med J. 2003; 79(935):511-5. PMC: 1742823. DOI: 10.1136/pmj.79.935.511. View

Salvarani C, Della Bella C, Cimino L, Macchioni P, Formisano D, Bajocchi G . Risk factors for severe cranial ischaemic events in an Italian population-based cohort of patients with giant cell arteritis. Rheumatology (Oxford). 2008; 48(3):250-3. DOI: 10.1093/rheumatology/ken465. View

Bajko Z, Balasa R, Maier S, Motataianu A, Barcutean L, Andone S . Stroke secondary to giant-cell arteritis: A literature review. Exp Ther Med. 2021; 22(2):876. PMC: 8237390. DOI: 10.3892/etm.2021.10308. View

Narvaez J, Bernad B, Gomez-Vaquero C, Garcia-Gomez C, Roig-Vilaseca D, Juanola X . Impact of antiplatelet therapy in the development of severe ischemic complications and in the outcome of patients with giant cell arteritis. Clin Exp Rheumatol. 2008; 26(3 Suppl 49):S57-62. View

Jennette J, Falk R, Bacon P, Basu N, Cid M, Ferrario F . 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2012; 65(1):1-11. DOI: 10.1002/art.37715. View

10.

Pariente A, Guedon A, Alamowitch S, Thietart S, Carrat F, Delorme S . Ischemic stroke in giant-cell arteritis: French retrospective study. J Autoimmun. 2019; 99:48-51. DOI: 10.1016/j.jaut.2019.01.009. View

11.

Gonzalez-Gay M, Vazquez-Rodriguez T, Gomez-Acebo I, Pego-Reigosa R, Lopez-Diaz M, Vazquez-Trinanes M . Strokes at time of disease diagnosis in a series of 287 patients with biopsy-proven giant cell arteritis. Medicine (Baltimore). 2009; 88(4):227-235. DOI: 10.1097/MD.0b013e3181af4518. View

12.

Aschwanden M, Kesten F, Stern M, Thalhammer C, Walker U, Tyndall A . Vascular involvement in patients with giant cell arteritis determined by duplex sonography of 2x11 arterial regions. Ann Rheum Dis. 2010; 69(7):1356-9. DOI: 10.1136/ard.2009.122135. View

13.

Zarka F, Rheaume M, Belhocine M, Goulet M, Febrer G, Mansour A . Colour Doppler ultrasound and the giant cell arteritis probability score for the diagnosis of giant cell arteritis: a Canadian single-centre experience. Rheumatol Adv Pract. 2021; 5(3):rkab083. PMC: 8633428. DOI: 10.1093/rap/rkab083. View

14.

Pang L . Hallucinations Experienced by Visually Impaired: Charles Bonnet Syndrome. Optom Vis Sci. 2016; 93(12):1466-1478. PMC: 5131689. DOI: 10.1097/OPX.0000000000000959. View

15.

Jones L, Ditzel-Finn L, Enoch J, Moosajee M . An overview of psychological and social factors in Charles Bonnet syndrome. Ther Adv Ophthalmol. 2021; 13:25158414211034715. PMC: 8330457. DOI: 10.1177/25158414211034715. View

16.

Soriano A, Muratore F, Pipitone N, Boiardi L, Cimino L, Salvarani C . Visual loss and other cranial ischaemic complications in giant cell arteritis. Nat Rev Rheumatol. 2017; 13(8):476-484. DOI: 10.1038/nrrheum.2017.98. View

17.

Blockmans D, De Ceuninck L, Vanderschueren S, Knockaert D, Mortelmans L, Bobbaers H . Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients. Arthritis Rheum. 2006; 55(1):131-7. DOI: 10.1002/art.21699. View

18.

de Boysson H, Liozon E, Lariviere D, Samson M, Parienti J, Boutemy J . Giant Cell Arteritis-related Stroke: A Retrospective Multicenter Case-control Study. J Rheumatol. 2017; 44(3):297-303. DOI: 10.3899/jrheum.161033. View

19.

Maz M, Chung S, Abril A, Langford C, Gorelik M, Guyatt G . 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Giant Cell Arteritis and Takayasu Arteritis. Arthritis Care Res (Hoboken). 2021; 73(8):1071-1087. DOI: 10.1002/acr.24632. View

20.

Fongaufier C, Guffroy A, Lutz J . Tongue and Scalp Necrosis: Simultaneous Initial Complications Revealing Giant Cell Arteritis. J Rheumatol. 2018; 45(6):873-874. DOI: 10.3899/jrheum.171321. View