Goyal Nitasha, Basnet Arjun, Donenfeld Thai T, Tiwari Kripa, Clemen Britney M, Kyaw Htin, Nwosu Ifeanyi, Ibeson Emeka C, Konka Sarita
Internal Medicine, State University of New York (SUNY) Downstate, Brooklyn, USA.
Internal Medicine, Maimonides Medical Center, Brooklyn, USA.
Cureus. 2022 Jul 1;14(7):e26483. doi: 10.7759/cureus.26483. eCollection 2022 Jul.
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.
巨细胞动脉炎（GCA），也称为颞动脉炎（TA），是一种累及中、大动脉的系统性自身免疫性炎症。它是影响50岁以上成年人最常见的血管炎，发病率为20/100,000，平均发病年龄为70岁。通常，患者最初表现为新发头痛、视力变化和障碍、颌部间歇性运动障碍、关节痛以及颞动脉或枕动脉压痛或肿胀。我们的患者是一名73岁男性，因双侧头痛10天前来急诊室，头痛放射至枕部区域，伴有发热、持续寒战、全身无力，其头痛被描述为持续性、钝痛，疼痛程度为10分制中的9分，颈部屈曲时疼痛轻微。实验室检查显示红细胞沉降率（ESR）和C反应蛋白（CRP）升高。患者颞部触诊有压痛，由于高度怀疑巨细胞动脉炎，开始给予高剂量类固醇治疗，其症状迅速缓解。活检显示有活动性非肉芽肿性血管炎的证据，并在临床背景下确诊为双侧颞动脉炎。GCA患者女性更为常见，通常表现为单侧头痛（66%的GCA患者）、颌部间歇性运动障碍（50%）、发热（50%）和短暂性视力丧失（16 - 54%）。在此，我们描述一名73岁男性，既往有脑血管意外（CVA）、糖尿病和癌症病史，出现双侧头痛和发热10天。与通常的表现不同，我们的患者否认有任何视力和关节疼痛变化，颞动脉触诊不硬。该患者的表现与以往报告不同，症状表现有限且缺乏最常见的相关表现。尽管其表现支持GCA，但ESR和CRP升高、头痛和发热这些特征过于笼统，不能仅凭这些就诊断为GCA，其流涕和鼻窦疼痛等额外症状更可能支持感染。我们的病例表明，对于出现头痛且ESR和CRP升高的老年人群，对GCA保持高度临床怀疑很重要。巨细胞动脉炎（GCA），也称为颞动脉炎（TA），是一种累及中、大动脉的系统性自身免疫性炎症。通常，患者最初表现为新发头痛、视力变化和障碍、颌部间歇性运动障碍、关节痛以及颞动脉或枕动脉压痛或肿胀。诊断需要高度临床怀疑，治疗以高剂量类固醇为核心。
