Lingual infarction and sudden blindness due to giant cell arteritis

Giant cell arteritis affecting the tongue: a case report and review of the literature

Giant cell arteritis (GCA) is a systemic vasculitis with symptoms that could cause a patient to present to a general dental practitioner. A case of GCA that presented as headache, jaw claudication, unilateral visual loss and tongue ulceration leading to necrosis is reported and the literature reviewed, with an emphasis on dentally relevant aspects. It is vital that GCA is not overlooked in patients over the age of 50 with unexplained dental pain, tissue necrosis or jaw pain which may be misdiagnosed as a temporomandibular joint disorder. Early diagnosis and prompt treatment is the key to preventing visual loss. Early referral in such cases would be warranted.

CLINICAL RELEVANCE

Dental clinicians may play a part in the early diagnosis of GCA by having a high index of suspicion for its symptoms in patients, so that devastating ischaemic consequences, such as irreversible visual loss, can be prevented.

Ulceration and necrosis of the tongue due to giant cell arteritis

A case is reported of giant cell arteritis in a 74-year-old woman, complicated by ulceration and necrosis of the tongue. During steroid treatment recovery was observed.

Temporal arteritis: report of a case

Temporal arteritis is a rheumatic disease that affects large and medium-sized arteries. It is a severe arteritis involving both the intima and media of the vessel and is a cause of headache that is frequently diagnosed erroneously as "atypical migraine." The patients have a burning or throbbing type of pain. Ultimately, there is localized inflammation or cellulitis over the swollen, tortuous artery. Jaw claudication, eye pain, photophobia, diplopia, and even blindness may accompany the temporal symptoms. As many as 20% to 60% of inadequately treated or untreated patients will lose their vision. Blindness may or may not be preceded by visual symptoms and funduscopic changes. A variety of systemic symptoms are also often present, including nausea, vomiting, chills, dizziness, and loss of weight. Temporal arteritis is not a common diagnosis in maxillofacial practice. We are presenting a case of temporal arteritis diagnosed after a biopsy. The patient eventually lost the vision from one eye.

Tongue necrosis as a complication of temporal arteritis

Tongue necrosis is a rare complication in giant cell arteritis, an entity in which both temporal arteritis and rheumatic polymyalgia may be included as two different manifestations of the same pathologic process. The case of a 79-year-old patient who had tongue necrosis 3 hours after ingestion of 2 mg of ergotamine tartrate is presented. This complication was the basis for the diagnosis of temporal arteritis. We reviewed possible clinical manifestations of temporal arteritis and cases of tongue necrosis in the world literature. The possible existence of triggering factors that seemed to be present in 11 of the published cases was analyzed. In seven of these cases ingestion of ergotamine derivates had taken place.

Necrosis of the tongue in a patient with intestinal infarction

A patient with a rare combination of bilateral lingual necrosis and intestinal infarction, caused by giant cell arteritis, is described and the literature reviewed.

On the occurrence of necrotising lesions in arteritis temporalis: review of the literature with a note on the potential risk of a biopsy

Against the background of a steadily growing proportion of elderly individuals within the populations in the Western countries, arteritis temporalis with its wide diversity of presenting symptoms in the elderly patient, including purely psychiatric ones, has become a disease of increasing interest to the medical profession. Increasing demands may be made on the surgeon, often a plastic surgeon, responsible for carrying out the biopsy that is necessary in arteritis temporalis for both diagnostic and therapeutic reasons. Attention is called to certain elements of risk inherent in taking a biopsy of an artery under local anaesthesia, and to the fact that the administration of ergotamine tartrate may provoke serious complications in this particular disease.