MEDICAL IMAGES
Scalp Necrosis in Giant Cell Arteritis Marco A. Alba, MD, and Maria C. Cid, MD
A
n 80-year-old man presented with a 2-week history of new onset headache, jaw claudication, and scalp tenderness. Physical examination revealed scalp necrosis with cyanosis of the surrounding skin (Figure) and a pulseless, thickened left temporal artery. Laboratory tests disclosed an elevated erythrocyte sedimentation rate and C-reactive protein concentration. Microscopic examination of the temporal artery showed characteristic findings of giant cell arteritis (Supplemental Figures 1 and 2): intimal hyperplasia with complete occlusion of the lumen, rupture of the internal elastic lamina, giant cells, and dense inflammatory infiltration of the artery wall. Treatment with high-dose glucocorticoids resulted in prompt resolution of symptoms. Healed scalp necrosis with a residual crust was observed after 10 days of treatment (Supplemental Figure 3). Differential diagnosis of scalp necrosis includes herpes zoster, contact dermatitis, pyoderma gangrenosum,
From the Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
FIGURE. Left-side scalp necrosis.
postradiation ulcers, bacterial infections, ulcerated skin tumors, and giant cell arteritis. SUPPLEMENTAL ONLINE MATERIAL Supplemental material can be found online at http://www.mayoclinicproceedings.org.
Mayo Clin Proc. n October 2014;89(10):e99 n http://dx.doi.org/10.1016/j.mayocp.2014.01.031 www.mayoclinicproceedings.org n ª 2014 Mayo Foundation for Medical Education and Research
e99
Scalp Necrosis in Giant Cell Arteritis Marco A. Alba, MD, and Maria C. Cid, MD
A
n 80-year-old man presented with a 2-week history of new onset headache, jaw claudication, and scalp tenderness. Physical examination revealed scalp necrosis with cyanosis of the surrounding skin (Figure) and a pulseless, thickened left temporal artery. Laboratory tests disclosed an elevated erythrocyte sedimentation rate and C-reactive protein concentration. Microscopic examination of the temporal artery showed characteristic findings of giant cell arteritis (Supplemental Figures 1 and 2): intimal hyperplasia with complete occlusion of the lumen, rupture of the internal elastic lamina, giant cells, and dense inflammatory infiltration of the artery wall. Treatment with high-dose glucocorticoids resulted in prompt resolution of symptoms. Healed scalp necrosis with a residual crust was observed after 10 days of treatment (Supplemental Figure 3). Differential diagnosis of scalp necrosis includes herpes zoster, contact dermatitis, pyoderma gangrenosum,
From the Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.
FIGURE. Left-side scalp necrosis.
postradiation ulcers, bacterial infections, ulcerated skin tumors, and giant cell arteritis. SUPPLEMENTAL ONLINE MATERIAL Supplemental material can be found online at http://www.mayoclinicproceedings.org.
Mayo Clin Proc. n October 2014;89(10):e99 n http://dx.doi.org/10.1016/j.mayocp.2014.01.031 www.mayoclinicproceedings.org n ª 2014 Mayo Foundation for Medical Education and Research
e99
