QJM: An International Journal of Medicine, 2015, 841 doi: 10.1093/qjmed/hcv099 Advance Access Publication Date: 15 May 2015 Clinical picture
CLINICAL PICTURE
Tongue necrosis in giant-cell arteritis
Biopsy of temporal artery remains the gold standard for diagnosis of giant cell arteritis. Timely diagnosis and treatment may resolve serious cases as this one we observed.
Figure 1. The patient with a triangular area of necrosis on the tip and labial right margin of the tongue.
Photographs and text from: N. Mumoli and M. Cei, Department of Internal Medicine, Ospedale Civile Livorno, 57100 Livorno, Italy; J. Vitale and F. Dentali, Department of Internal Medicine, Ospedale di Circolo Varese, 25100 Varese, Italy. e-mail: [email protected]
Reference 1. Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet 2008; 372:234–45.
C The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. V
All rights reserved. For Permissions, please email: [email protected]
841
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A 77-year-old woman was complaining of pain in the scapular cingulum since 3 months and pain and swelling in both the wrists, with elevated CRP. She began therapy with deflazacort, bisphosphonates and vitamin D. After a month the patient complained of frontal and bitemporal headache. Shortly after, the patient had intense onset pain in the tongue and referred transient reduction in visual acuity. A triangular area of necrosis with eschar, corresponding to the territory of right dorsal branch of the lingual artery, was observed on the tip and labial right margin of the tongue. Ultrasonography of temporal arteries was performed, and it evidenced occlusion of both the temporal arteries. PET total body, MRI and MRI angiography of the brain showed no involvement of other major vessels. Biopsy of temporal artery was performed and histopathological examination revealed an inflammation with giant cells. Therapy with prednisone, methotrexate, ASA, bisphosphonates and vitamin D was suggested. Prompt treatment with steroids and local measures resulted in initial healing of the lesion, and eschar fell spontaneously leaving a triangular area cleansed aching (Figure 1). Giant-cell arteritis often begins with headache, swelling of temporal artery, systemic symptoms, polymyalgia, change in vision, sometime with TIA/stroke, jaw claudication.1 The report shows an atypical manifestation of giant-cell arteritis. Therefore, in the case of symptoms of inflammation and pain in one area of the head, in patients older than 50 years, giant-cell arteritis should be considered in differential diagnosis.
CLINICAL PICTURE
Tongue necrosis in giant-cell arteritis
Biopsy of temporal artery remains the gold standard for diagnosis of giant cell arteritis. Timely diagnosis and treatment may resolve serious cases as this one we observed.
Figure 1. The patient with a triangular area of necrosis on the tip and labial right margin of the tongue.
Photographs and text from: N. Mumoli and M. Cei, Department of Internal Medicine, Ospedale Civile Livorno, 57100 Livorno, Italy; J. Vitale and F. Dentali, Department of Internal Medicine, Ospedale di Circolo Varese, 25100 Varese, Italy. e-mail: [email protected]
Reference 1. Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet 2008; 372:234–45.
C The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. V
All rights reserved. For Permissions, please email: [email protected]
841
Downloaded from by guest on November 18, 2015
A 77-year-old woman was complaining of pain in the scapular cingulum since 3 months and pain and swelling in both the wrists, with elevated CRP. She began therapy with deflazacort, bisphosphonates and vitamin D. After a month the patient complained of frontal and bitemporal headache. Shortly after, the patient had intense onset pain in the tongue and referred transient reduction in visual acuity. A triangular area of necrosis with eschar, corresponding to the territory of right dorsal branch of the lingual artery, was observed on the tip and labial right margin of the tongue. Ultrasonography of temporal arteries was performed, and it evidenced occlusion of both the temporal arteries. PET total body, MRI and MRI angiography of the brain showed no involvement of other major vessels. Biopsy of temporal artery was performed and histopathological examination revealed an inflammation with giant cells. Therapy with prednisone, methotrexate, ASA, bisphosphonates and vitamin D was suggested. Prompt treatment with steroids and local measures resulted in initial healing of the lesion, and eschar fell spontaneously leaving a triangular area cleansed aching (Figure 1). Giant-cell arteritis often begins with headache, swelling of temporal artery, systemic symptoms, polymyalgia, change in vision, sometime with TIA/stroke, jaw claudication.1 The report shows an atypical manifestation of giant-cell arteritis. Therefore, in the case of symptoms of inflammation and pain in one area of the head, in patients older than 50 years, giant-cell arteritis should be considered in differential diagnosis.
![[Necrosis of the tongue in temporal arteritis. Case report].](/assets/img/hold.png)
