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Mehta P, Sattui SE, van der Geest KSM, Brouwer E, Conway R, Putman MS, Robinson PC, Mackie SL. Giant Cell Arteritis and COVID-19: Similarities and Discriminators. A Systematic Literature Review. J Rheumatol 2020; 48:1053-1059. [PMID: 33060304 DOI: 10.3899/jrheum.200766] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify shared and distinct features of giant cell arteritis (GCA) and coronavirus disease 2019(COVID-19) to reduce diagnostic errors that could cause delays in correct treatment. METHODS Two systematic literature reviews determined the frequency of clinical features of GCA and COVID-19 in published reports. Frequencies in each disease were summarized using medians and ranges. RESULTS Headache was common in GCA but was also observed in COVID-19 (GCA 66%, COVID-19 10%). Jaw claudication or visual loss (43% and 26% in GCA, respectively) generally were not reported in COVID-19. Both diseases featured fatigue (GCA 38%, COVID-19 43%) and elevated inflammatory markers (C-reactive protein [CRP] elevated in 100% of GCA, 66% of COVID-19), but platelet count was elevated in 47% of GCA but only 4% of COVID-19 cases. Cough and fever were commonly reported in COVID-19 and less frequently in GCA (cough, 63% for COVID-19 vs 12% for GCA; fever, 83% for COVID-19 vs 27% for GCA). Gastrointestinal upset was occasionally reported in COVID-19 (8%), rarely in GCA (4%). Lymphopenia was more common in COVID-19 than GCA (53% in COVID-19, 2% in GCA). Alteration of smell and taste have been described in GCA but their frequency is unclear. CONCLUSION Overlapping features of GCA and COVID-19 include headache, fever, elevated CRP and cough. Jaw claudication, visual loss, platelet count and lymphocyte count may be more discriminatory. Physicians should be aware of the possibility of diagnostic confusion. We have designed a simple checklist to aid evidence-based evaluation of patients with suspected GCA.
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Affiliation(s)
- Puja Mehta
- P. Mehta, Rheumatology Fellow, MD, Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, Department of Rheumatology, University College London Hospital (UCLH) NHS Trust, London, UK
| | - Sebastian E Sattui
- S.E. Sattui, Rheumatology Fellow, MD, Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Kornelis S M van der Geest
- K. van der Geest, Rheumatology Fellow, PhD, E. Brouwer, Internist Rheumatologist, Associate Professor, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Elisabeth Brouwer
- K. van der Geest, Rheumatology Fellow, PhD, E. Brouwer, Internist Rheumatologist, Associate Professor, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard Conway
- R. Conway, Consultant Rheumatologist, PhD, Department of Rheumatology, St. James's Hospital, Dublin, Ireland
| | - Michael S Putman
- M.S. Putman, Clinical Instructor of Medicine, MD, Division of Rheumatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Philip C Robinson
- P. Robinson, Associate Professor, PhD, University of Queensland Faculty of Medicine, Brisbane, Australia
| | - Sarah L Mackie
- S.L. Mackie, Associate Clinical Professor and Honorary Consultant Rheumatologist, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Rubenstein E, Maldini C, Gonzalez-Chiappe S, Chevret S, Mahr A. Sensitivity of temporal artery biopsy in the diagnosis of giant cell arteritis: a systematic literature review and meta-analysis. Rheumatology (Oxford) 2020; 59:1011-1020. [PMID: 31529073 DOI: 10.1093/rheumatology/kez385] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/30/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Temporal artery biopsy (TAB) is a reference test for the diagnosis of GCA but reveals inflammatory changes only in a subset of patients. The lack of knowledge of TAB sensitivity hampers comparisons with non-invasive techniques such as temporal artery ultrasonography. We performed a systematic literature review and meta-analysis to estimate the sensitivity of TAB in GCA and to identify factors that may influence the estimate. METHODS A systematic literature review involved searching electronic databases and cross-references. Eligibility criteria included publications reporting at least 30 GCA cases fulfilling the original or modified 1990 ACR classification criteria. The pooled proportion of TAB-positive GCA cases was calculated by using aggregated-data meta-analysis with a random-effects model and assessment of heterogeneity with the I2 statistic. Subgroup analyses and meta-regression were used to examine the effect of patient and study characteristics on TAB positivity. RESULTS Among 3820 publications screened, 32 studies (3092 patients) published during 1993-2017 were analysed. The pooled proportion of TAB-positive GCA cases was 77.3% (95% CI: 71.8, 81.9%), with high between-study heterogeneity (I2 = 90%). The proportion of TAB-positive cases was slightly higher in publications before than in 2012 and after (P = 0.001). CONCLUSION The estimated sensitivity of 77% provides indirect evidence that TAB is not less sensitive than temporal artery imaging. The unexplained high between-study heterogeneity could result from differences in TAB sampling, processing or interpretation. The decrease in TAB-positive GCA cases over time could reflect an increasing propensity for clinicians to accept a GCA diagnosis without proof by TAB.
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Affiliation(s)
- Emma Rubenstein
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot
| | - Carla Maldini
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot
| | | | - Sylvie Chevret
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot
| | - Alfred Mahr
- Department of Internal Medicine, Hospital Saint-Louis, University Paris Diderot
- ECSTRRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center UMR 1153, Inserm, Paris, France
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Hori H, Kobashigawa T, Fukuchi T, Sugawara H. Giant cell arteritis manifested by chronic dry cough. BMJ Case Rep 2020; 13:13/6/e234734. [PMID: 32565438 DOI: 10.1136/bcr-2020-234734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A 77-year-old man visited the hospital with a chronic cough persisting for 2.5 months accompanied with night sweats, weight loss (3.5 kg) and elevated C-reactive protein level. Chest CT of the lung field was normal, but aortic wall thickening accompanied by a contrast effect was noted. Positron emission tomography-CT (PET-CT) showed that the aorta and subclavian artery were inflamed, suggesting large-vessel vasculitis. Ultrasonography showed thickening of the superficial temporal artery wall (macaroni sign). Biopsy revealed lymphocytic infiltration in the tunica media and foreign-body giant cell reaction with the elastic lamina, resulting in a diagnosis of giant cell arteritis (GCA). The cough was considered a symptom of GCA as it resolved following prednisolone administration. Cough may rarely be an initial GCA symptom. However, for chronic cough accompanied with elevated inflammatory findings but with a normal lung field, imaging studies such as PET-CT are useful for the differential diagnosis.
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Affiliation(s)
- Hiroshi Hori
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tsuyoshi Kobashigawa
- Division of Rheumatology, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takahiko Fukuchi
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hitoshi Sugawara
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Fenot M, Riegert M, Poiraud C, Gegu M, André V. [Extensive cutaneous lesions]. Rev Med Interne 2017; 40:60-61. [PMID: 28844396 DOI: 10.1016/j.revmed.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/22/2017] [Indexed: 11/26/2022]
Affiliation(s)
- M Fenot
- Service de dermatologie, CHD Vendée, Les Oudairies, boulevard Stéphane-Moreau, 85925 La Roche-sur-Yon, France.
| | - M Riegert
- Cabinet libéral de dermatologie, 48, rue de Verdun, 85000 La Roche-sur-Yon, France
| | - C Poiraud
- Service de dermatologie, CHD Vendée, Les Oudairies, boulevard Stéphane-Moreau, 85925 La Roche-sur-Yon, France
| | - M Gegu
- Service de gériatrie, CHD Vendée, Les Oudairies, boulevard Stéphane-Moreau, 85925 La Roche-sur-Yon, France
| | - V André
- Service de rhumatologie, CHD Vendée, Les Oudairies, boulevard Stéphane-Moreau, 85925 La Roche-sur-Yon, France
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Mahfoudhi M, Mamlouk H, Turki S, Kheder A. [Horton disease revealed by dyspnea]. Pan Afr Med J 2015; 20:248. [PMID: 26161171 PMCID: PMC4484402 DOI: 10.11604/pamj.2015.20.248.4656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022] Open
Abstract
Les manifestations pleuro-pulmonaires de la maladie de Horton sont rares et peu connues. Elles peuvent être inaugurales, à l'origine d'un retard à la prise en charge si elles sont méconnues. Il s'agissait d'un patient âgé de 75 ans, admis pour une dyspnée, une toux chronique et une fièvre. Il a reçu une antibiothérapie et a bénéficié d'une fibroscopie bronchique avec lavage broncho-alvéolaire à la recherche d'un germe, qui a révélé plutôt, une alvéolite lymphocytaire. L’évolution était marquée par la persistance des signes cliniques et du syndrome inflammatoire biologique. Un angio-scanner thoracique et une échographie cardiaque étaient sans anomalies. Une origine cardiaque, musculaire, hématologique, néoplasique, vasculaire ou métabolique de la dyspnée a été éliminée. Une maladie de Horton a été évoquée. La biopsie de l'artère temporale a confirmé le diagnostic d'une maladie de Horton. L’évolution sous corticothérapie était marquée par la disparition des signes cliniques et biologiques. Les manifestations pleuro-pulmonaires au cours de la maladie de Horton sont rares, et classiquement, rarement révélatrices de la maladie. La dyspnée peut initialement égarer le diagnostic vers d'autres étiologies notamment infectieuses. Le but de ce travail est d'insister sur le fait que la connaissance de ces différentes manifestations respiratoires au cours de la maladie de Horton (toux persistante, dyspnée, épanchement pleural) est utile au clinicien afin de prescrire une corticothérapie, chez un sujet le plus souvent âgé ayant un état fébrile et inflammatoire prolongé, permettant ainsi d’éviter l'apparition de complications.
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Affiliation(s)
- Madiha Mahfoudhi
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Habiba Mamlouk
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Sami Turki
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie
| | - Adel Kheder
- Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie
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Ouraini S, Rouihi A, Nakkabi I, Benariba F. [Tinnitus indicative of Horton disease]. Pan Afr Med J 2015; 22:309. [PMID: 26966505 PMCID: PMC4769053 DOI: 10.11604/pamj.2015.22.309.7780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/14/2015] [Indexed: 12/02/2022] Open
Abstract
La maladie de Horton est une artérite giganto-cellulaire touchant les artères de gros et de moyen calibre du territoire céphalique. Elle a une expression clinico-biologique polymorphe. Le diagnostic de certitude est posé devant des formes typiques comportant des critères diagnostiques cliniques et paracliniques établis par l'ACR (American College of Rhumatology). Cependant certaines formes atypiques de la maladie peuvent faire retarder le diagnostic, c'est le cas notamment des formes révélées par des manifestations ORL qui sont inhabituelles et peu spécifiques. Le but de ce travail est de rapporter un cas atypique de la maladie de Horton révélé par des acouphènes, le retard diagnostique pouvant être à l'origine d'une mauvaise prise en charge thérapeutique, avec des risques de complications vasculaires graves.
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Affiliation(s)
- Saloua Ouraini
- Service d'ORL et CCF, Hôpital Militaire d'Instruction Mohammed V, CHU Ibn Sina, Rabat, Maroc
| | - Ahmed Rouihi
- Service d'ORL et CCF, Hôpital Militaire d'Instruction Mohammed V, CHU Ibn Sina, Rabat, Maroc
| | - Ismail Nakkabi
- Service d'ORL et CCF, Hôpital Militaire d'Instruction Mohammed V, CHU Ibn Sina, Rabat, Maroc
| | - Fouad Benariba
- Service d'ORL et CCF, Hôpital Militaire d'Instruction Mohammed V, CHU Ibn Sina, Rabat, Maroc
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Cuvelier C, Kremer B, Kawski H, Guichard JF, Maurier F. [Subcutaneous nodules of the head and neck heralding giant cell arteritis]. Ann Dermatol Venereol 2014; 141:518-22. [PMID: 25209815 DOI: 10.1016/j.annder.2014.04.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/25/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Giant cell arteritis is the most common form of systemic vasculitis affecting individuals aged over 50 years. While its clinical manifestations are numerous, cutaneous involvement is uncommon and rarely constitutes the initial sign. We discuss a case of atypical skin involvement as the initial symptom of giant cell arteritis. OBSERVATION An 86-year-old woman presented purplish and painful subcutaneous nodules on the scalp and neck. Biological explorations showed systemic inflammation. The skin biopsy was evocative of polyarteritis nodosa. The nodules spontaneously disappeared completely, and asthenia and bitemporal headache gradually appeared. In view of the persistent inflammatory syndrome, a diagnosis of giant cell arteritis was proposed and was later confirmed by the temporal artery biopsy sample, with its typical histological appearance. Systemic corticosteroids resulted in complete regression of symptoms within a few days. DISCUSSION To our knowledge, inflammatory cervical subcutaneous nodules have never been described in giant cell arteritis. The case we report herein thus raises the issue of differential diagnosis between various forms of vasculitis. While classification of the latter continues to progress thanks to improvements in physiopathological knowledge, the distinction between vasculitis of the large and small vessels remains tenuous on occasion. We discuss the differential diagnoses. CONCLUSION The dermatological presentation of giant cell arteritis in the present case suggests the existence of a continuum between small-, medium- and large-vessel vasculitis.
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Affiliation(s)
- C Cuvelier
- Hôpitaux privés de Metz, rue Belle-Isle, 57000 Metz, France.
| | - B Kremer
- 5, avenue de la République, 54150 Briey, France
| | - H Kawski
- Hôpitaux privés de Metz, rue Belle-Isle, 57000 Metz, France
| | - J-F Guichard
- Hôpitaux privés de Metz, rue Belle-Isle, 57000 Metz, France
| | - F Maurier
- Hôpitaux privés de Metz, rue Belle-Isle, 57000 Metz, France
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8
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Krug S, Portig I, Librizzi D, Pfestroff A, Gress T, Michl P. [A 79-year-old man with B symptoms and jaw claudication]. Internist (Berl) 2013; 54:249-53. [PMID: 23325121 DOI: 10.1007/s00108-012-3223-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 79-year-old patient presented with weight loss, subfebrile body temperature and unclear jaw pain. After ruling out malignant and infectious causes, positron emission tomography-computed tomography (PET-CT) revealed markedly elevated glucose utilization of the large thoracic and upper limb arteries, suggesting systemic vasculitis. Color-coded duplex sonography confirmed thickening of the wall of the external carotid artery consistent with vasculitis. The patient was diagnosed with giant cell arteritis involving the large thoracic arteries and the upper limb arteries but without involvement of the superficial temporal artery. Based on the involvement of the external carotid artery, the jaw pain could be classified as jaw claudication. Clinical and laboratory remission was achieved with systemic glucocorticoids which could subsequently be tapered. The patient is well and asymptomatic 12 months after diagnosis and 2 months without steroids.
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Affiliation(s)
- S Krug
- Klinik für Gastroenterologie, Endokrinologie und Stoffwechsel, Philipps-Universität Marburg, Baldingerstr. 1, 35043, Marburg
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Zenone T, Puget M. Dry cough is a frequent manifestation of giant cell arteritis. Rheumatol Int 2012; 33:2165-8. [PMID: 22451028 DOI: 10.1007/s00296-012-2415-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 03/11/2012] [Indexed: 01/08/2023]
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Kassem H, El Gharbi T, Hamadi K, Dresco E, Turner L. Toux chronique révélant une maladie de Horton. Rev Med Interne 2011; 32:e76-8. [DOI: 10.1016/j.revmed.2010.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 04/16/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
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Carassou P, Aletti M, Cinquetti G, Banal F, Landais C, Graffin B, Carli P. Atteinte respiratoire de la maladie de Horton : 8 observations et revue de la littérature. Presse Med 2010; 39:e188-96. [DOI: 10.1016/j.lpm.2010.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 01/10/2010] [Accepted: 01/12/2010] [Indexed: 11/29/2022] Open
Affiliation(s)
- Philippe Carassou
- HIA Legouest, service de médecine interne, BP 90001, 57077 Metz cedex 3, France.
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Abstract
Giant cell arteritis (GCA) is the most common primary vasculitis of adults. The incidence of this disease is practically nil in the population under the age of 50 years, then rises dramatically with each passing decade. The median age of onset of the disease is about 75 years. As the ageing population expands, it is increasingly important for ophthalmologists to be familiar with GCA and its various manifestations, ophthalmic and non-ophthalmic. A heightened awareness of this condition can avoid delays in diagnosis and treatment. It is well known that prompt initiation of steroids remains the most effective means for preventing potentially devastating ischaemic complications. This review summarizes the current concepts regarding the immunopathogenetic pathways that lead to arteritis and the major phenotypic subtypes of GCA with emphasis on large vessel vasculitis, novel modalities for disease detection and investigative trials using alternative, non-steroid therapies.
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Affiliation(s)
- Aki Kawasaki
- Department of Neuro-ophthalmology, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland.
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Wierzbicka-Hainaut E, Anyfantakis V, Bonnefoy M, Miremont H, Bonneric-Malthieu F, Guillet G. [Scalp necrosis revealing Horton's disease]. Ann Dermatol Venereol 2008; 135:890-1. [PMID: 19084710 DOI: 10.1016/j.annder.2008.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 04/25/2008] [Indexed: 10/21/2022]
Affiliation(s)
- E Wierzbicka-Hainaut
- Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
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Néel A, Agard C, Chevalet P, Moreau A, Hamidou M. [Skull metastase masquerading as temporal arteritis: report of two cases]. Rev Med Interne 2008; 30:340-4. [PMID: 19026471 DOI: 10.1016/j.revmed.2008.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 09/21/2008] [Accepted: 10/05/2008] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Temporal arteritis is the most common systemic vasculitis of the elderly. A definitive diagnosis is obtained on temporal artery biopsy examination (TAB). However, 30% of TAB yields false negative results. In such cases, diagnosis relies on clinical presentation and exclusion of alternative diagnosis. Conversely, false positive TAB are uncommon. CASE REPORTS We report two patients who presented with headache, scalp tenderness and increased acute phase reactants, suggesting temporal arteritis, but which turned out to reveal a skull metastase. Temporal artery biopsy performed in one case demonstrated arterial wall inflammation. CONCLUSION Clinicians must be aware that a skull lesion can mimick temporal arteritis.
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Affiliation(s)
- A Néel
- Service de médecine interne, CHU Hôtel-Dieu, place Alexis-Ricordeau, 44000 Nantes, France.
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Guindon A, Rossi P, Bagneres D, Aissi K, Demoux AL, Bonin-Guillaume S, Cloarec N, Giraud F, Timponne S, Le Dolley Y, Fenerol M, Dales JP, Frances Y, Granel B. [Pericarditis: a giant cell arteritis manifestation]. Rev Med Interne 2007; 28:326-31. [PMID: 17335942 DOI: 10.1016/j.revmed.2007.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 01/27/2007] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Temporal arteritis is a vasculitis in which inflammatory manifestations mainly involve the external carotid artery area but not exclusively. Through a clinical observation and a review of the literature, we suggest that inflammatory pericarditis could represent a manifestation of temporal arteritis. EXEGESIS A 75-year-old-woman was admitted for progressive physical deterioration which had been evolving for three months, associated with fever, frontotemporal cephalalgia and severe biological inflammatory syndrome. Chest X-ray reveals a cardiomegaly and suggests a pericarditis, which was rapidly confirmed by echocardiogram. Temporal artery biopsy concludes to the diagnosis of a giant cell arteritis. Steroids treatment is prescribed, leading to a rapid regression of the inflammatory state and the pericarditis without relapse after 6 months of follow-up. CONCLUSION Only prospective studies on systematic echocardiography when faced with the diagnosis of giant cell arteritis, whatever clinical symptoms, will enable to appreciate the prevalence and prognosis value of this manifestation. Moreover, temporal artery analysis seems to be justified when faced with a sub-acute or chronic "idiopathic" inflammatory pericarditis occurring in the elderly patient. Physiopathogeny is unknown but some hypothesis can be proposed: inflammatory cytokines storm, immune complexes deposition, giant cell vasculitis of pericardial arteries or inflammatory interstitial lesion of the pericardium with or without granuloma.
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Affiliation(s)
- A Guindon
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (APHM), chemin des Bourrelys, 13915 Marseille, France
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Ponge T, Tessier MH, Lemeur F, Barrier JH. [A face's skin aspect simulating erysipelas revealing giant cell arteritis]. Rev Med Interne 2005; 26:911-3. [PMID: 16185787 DOI: 10.1016/j.revmed.2005.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 06/29/2005] [Indexed: 11/16/2022]
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Blaise S, Liozon E, Nadalon S, Vidal E. Maladie de Horton et plexite brachiale C5–C6 : une observation avec revue de la littérature. Rev Med Interne 2005; 26:578-82. [PMID: 15953663 DOI: 10.1016/j.revmed.2005.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 03/17/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND Shoulder palsy due to brachial plexopathy (or lower cervical radiculopathy) is a rare occurrence in patients with giant cell temporal arteritis (TA). We report a patient with C5 plexopathy revealing TA, with review of the literature. EXEGESIS A 67-year-old woman presented with a complex neurological syndrome of rapid onset, including a left trigeminal neuralgia, painless masticatory palsy, impaired swallowing, and severe palsy of the left shoulder, corresponding to a C5 plexitis. Giant cell arteritis was suspected on clinical and laboratory grounds and was documented on temporal artery biopsy. Treatment with pulse methylprednisolone (100 mg every 8 hours for three days), followed by prednisone (1 mg/kg daily), resulted in progressive improvement of the neurological deficits, full shoulder strength being recovered within 6 months. An extensive world literature allowed us to review 23 other cases of TA complicated by either lower cervical radiculopathy or C5 brachial plexopathy. These peripheral neuropathic manifestations occurred sometimes bilaterally and were isolated or, less often, part of a mononeuritis multiplex. Involved patients were relatively young (mean age 67 years) and 54% were men. The pathophysiology of TA-associated C5 radiculopathy or brachial plexitis is still poorly understood. Fortunately, functional prognosis was consistently good with corticosteroid treatment. CONCLUSION Giant cell arteritis should always be considered in elderly or middle-aged patients presenting with C5 radiculopathy or plexopathy and elevated inflammatory markers.
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Affiliation(s)
- S Blaise
- Service de médecine interne A, hôpital universitaire Dupuytren, 87042 Limoges, France
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Van der Schueren B, Lambert M. Cough as the presenting symptom of large vessel vasculitis. Clin Rheumatol 2005; 24:411-4. [PMID: 15650810 DOI: 10.1007/s10067-004-1052-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 10/12/2004] [Indexed: 10/25/2022]
Abstract
We report the case of a 57-year-old woman presenting with persistent cough, weight loss, and fever. An extensive work-up revealed laboratory signs of inflammation and a mild thickening of the aortic wall on computed tomographic scan of the thorax. These findings raised the suspicion of large vessel vasculitis that was elegantly confirmed by fluorodeoxyglucose positron emission tomography. Persistent cough as the inaugural symptom and involvement of large vessels in Horton's disease are also discussed.
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Affiliation(s)
- B Van der Schueren
- Division of General Internal Medicine, Cliniques universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium
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Abstract
Giant cell arteritis (GCA), temporal arteritis or Horton's arteritis, is a systemic vasculitis which involves large and medium sized vessels, especially the extracranial branches of the carotid arteries, in persons usually older than 50 years. Permanent visual loss, ischaemic strokes, and thoracic and abdominal aortic aneurysms are feared complications of GCA. The treatment consists of high dose steroids. Mortality, with a correct treatment, in patients with GCA seems to be similar that of controls.
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Affiliation(s)
- J M Calvo-Romero
- Internal Medicine, Hospital de Zafra, Antigua Ctra Nacional 432, Spain.
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Porcel-Pérez JM, Ruiz-González A. [Chronic cough and fever at the onset of giant cell arteritis]. Arch Bronconeumol 2003; 39:94. [PMID: 12586051 DOI: 10.1016/s0300-2896(03)75330-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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