Department of General Medicine, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
Mod Rheumatol Case Rep. 2020 Jul;4(2):283-288. doi: 10.1080/24725625.2019.1703547. Epub 2019 Dec 20.
Giant cell arteritis (GCA) is a type of vasculitis that occurs among the elderly and is categorised as granulomatous vasculitis of large- and medium-sized vessels. We herein report a case of GCA in a 78-year-old woman with an 11-month history of erythema nodosum (EN). She presented with fever, chest pain and headache. Inflammatory markers, including C-reactive protein and the erythrocyte sedimentation rate, were elevated. Computed tomography (CT) revealed thickening of the arterial walls from the aortic arch. Positron emission tomography/CT showed uptake of F-fluorodeoxyglucose in the walls of the proximal left common carotid and left subclavian arteries. The presence of temporal arteritis could not be confirmed. We diagnosed the patient with large-vessel GCA (LV-GCA). Induction therapy with prednisolone resulted in the rapid amelioration of her symptoms and inflammation. Cutaneous manifestations other than scalp necrosis in GCA are uncommon. In this case, EN preceded the onset of LV-GCA. The present case suggests EN can be a clinical manifestation of LV-GCA.
巨细胞动脉炎(GCA)是一种发生于老年人的血管炎,属于大、中型血管的肉芽肿性血管炎。本文报告了一例 78 岁女性的 GCA 病例,该患者有 11 个月的结节性红斑(EN)病史。她表现出发热、胸痛和头痛。炎症标志物,包括 C 反应蛋白和红细胞沉降率升高。计算机断层扫描(CT)显示从主动脉弓开始的动脉壁增厚。正电子发射断层扫描/CT 显示左颈总动脉和左锁骨下动脉近端壁摄取 F-氟脱氧葡萄糖。不能确认颞动脉炎的存在。我们诊断患者为大血管 GCA(LV-GCA)。泼尼松龙诱导治疗使她的症状和炎症迅速改善。GCA 除头皮坏死外,其他皮肤表现并不常见。在本例中,EN 先于 LV-GCA 发作。本病例提示 EN 可能是 LV-GCA 的一种临床表现。