孤立性舌坏死情况下巨细胞动脉炎的延迟诊断
Delayed Diagnosis of Giant Cell Arteritis in the Setting of Isolated Lingual Necrosis.
作者信息
DeBord Logan Christopher, Chiu Ilene, Liou Nelson Eddie
机构信息
Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
出版信息
Clin Med Insights Case Rep. 2019 Jun 20;12:1179547619857690. doi: 10.1177/1179547619857690. eCollection 2019.
BACKGROUND
Lingual necrosis is a rare complication of giant cell arteritis (GCA).
METHODS
A 77-year-old woman presented for treatment of a painful and discolored tongue, odynophagia, and dehydration refractory to antimicrobials over 2 weeks. An extensive, well-demarcated necrotic area was visualized on the anterior tongue upon admission. Leukocytosis, thrombocytosis, and elevated erythrocyte sedimentation rate were present. Computed tomography angiogram of the head and neck revealed an undulated-beaded appearance of the distal internal carotid arteries and vertebral arteries bilaterally.
RESULTS
High-dose intravenous steroids were initiated for suspected vasculitis. Temporal artery biopsy confirmed the diagnosis of GCA. The patient's condition improved and the anterior tongue was well healed at 1 month follow-up.
CONCLUSIONS
An atypical presentation of GCA (eg, isolated lingual necrosis) risks a delay in diagnosis and increased morbidity. Any patient above the age of 50 years presenting with tongue necrosis, in the absence of known cause, should undergo expedited workup for GCA.
背景
舌坏死是巨细胞动脉炎（GCA）的一种罕见并发症。
方法
一名77岁女性因舌部疼痛、变色、吞咽痛以及两周来使用抗菌药物治疗无效的脱水症状前来就诊。入院时可见舌前部有大片界限清晰的坏死区域。存在白细胞增多、血小板增多以及红细胞沉降率升高。头颈部计算机断层血管造影显示双侧颈内动脉远端和椎动脉呈波浪状串珠样外观。
结果
因怀疑血管炎开始使用大剂量静脉类固醇治疗。颞动脉活检确诊为GCA。患者病情改善，1个月随访时舌前部愈合良好。
结论
GCA的非典型表现（如孤立性舌坏死）有诊断延迟和发病率增加的风险。任何50岁以上出现舌坏死且无已知病因的患者，都应尽快进行GCA相关检查。
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