SUMMARY An elderly man developed temporal arteritis and polymyalgia rheumatica with coexisting biochemical abnormalities of liver function. Biopsy revealed hepatic changes which have not been previously reported. There was hepatocellular necrosis and inflammation together with a prominent hyperplasia of perisinusoidal lipocytes of Ito. Temporal artery biopsy confirmed the presence of granulomatous panarteritis. Corticosteroid therapy produced rapid resolution of symptoms and reversion of liver function tests to normal.The association of giant cell (temporal) arteritis with polymyalgia rheumatica is well recognised.'Most workers now accept polymyalgia rheumatica as a clinical manifestation of giant cell arteritis,2 3 and temporal arteritis has also been observed following treatment of polymyalgia rheumatica.Little is known about the systemic effects of giant cell arteritis. Lesions of the myocardium, kidneys, gastrointestinal tract, and nervous system have been attributed to underlying arteritis.5 Changes in liver function tests have frequently been documented. These changes have been variable, with elevation of alkaline phosphatase being the most frequent abnormality.6 7 The histology of liver biopsies from these patients has mainly been normal.2 In some instances nonspecific fatty change was found,8 and single granulomas were described in 2 cases.7 9 We report a case of giant cell arteritis with hepatocellular necrosis and hyperplasia of perisinusoidal lipocytes of Ito, histological changes which hitherto have not been described in this syndrome. Case reportA 64-year-old man presented with a 3-month history of right-sided intermittent facial pain. His headache and facial pain became continuous and were asso-

Objective To define the association between time taken to present to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS) and 1-year outcomes. We also determined whether particular patient characteristics are associated with delays in seeking care after symptom onset. Methods We collected data, which included a customised case report form to record symptom onset, on adult patients presenting with suspected ACS to two EDs in Australia and New Zealand. Such patients were followed up prospectively for 1 year. The composite primary endpoint included death, acute myocardial infarction, unstable angina pectoris treated with revascularisation or readmission with heart failure occurring after discharge but within 12 months after the index presentation.

Patients with antineutrophil cytoplasmic antibody‐associated vasculitis (AAV) are vulnerable to opportunistic infections, including cytomegalovirus (CMV) infection. This narrative review aims to identify factors associated with CMV infection in patients with AAV. The literature review was conducted on Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, PubMed, Scopus, and Web of Science. The start date of the literature search was unrestricted and the end date was February 2022. CMV infection was defined as (a) CMV pp65 antigenemia or positive CMV DNA viral load by polymerase chain reaction or CMV detection on histological specimens, with associated signs and symptoms compatible with CMV infection; (b) presence of CMV clinical syndrome (defined as presence of compatible symptoms and signs and documentation of CMV by biopsy by virus isolation, rapid culture, immunohistochemistry, or DNA in biopsy material as defined by the CMV Drug Development Forum); and (c) CMV infection as coded by the International Statistical Classification of Diseases and Related Health Problems, 10th revision with at least one prescription for CMV treatment. We identified 4505 articles, of which three (2327 patients with AAV) were included. All studies were retrospective and only one of the three studies included only patients with AAV. Low or decreasing lymphocyte counts and higher prednisolone usage were associated with CMV infection in patients with AAV. Patients with AAV with lymphopenia and on high doses of prednisolone should be monitored closely for signs and symptoms of CMV infection, and might benefit from CMV prophylaxis. Prospective studies are urgently needed to better identify causes of CMV infections in patients with AAV.

BackgroundA better understanding of the patients' perspectives is pivotal in the development of patient-reported outcomes (PROs) in vasculitis.ObjectivesTo assessed patients' perspective of disease amongst cases with Giant Cell Arteritis (GCA) compared to comparator illnesses mimicking large vessel vasculitis (LVV) included in the Diagnostic and Classification Criteria in Vasculitis Study (DCVAS) database.MethodsPatient Description of Illness (PDI) forms were circulated amongst Centres participating in the DCVAS study. The PDI form records up to 10 free-text severity ranked symptoms in descending order of severity, a body-map to localise the sites of pain and a free-text short summary of illness description. Free text was reorganized through content and thematic analysis.ResultsPDI forms from 89 patients with GCA and 28 comparators (COM) were analysed. There was no difference in age and sex distribution between groups (mean age 70±8 for GCA and 69±12 for COM). The symptoms description and frequency of the first most severe aspect of disease, including the patient's own words, is presented in Table 1. The symptom regarded as the most severe by both groups was headache. While there were no differences in the frequency of sudden visual loss, visual symptoms were reported more commonly as the most severe feature by COM vs GCA (21% vs 8%, p=0.05). Arthralgia was more frequently reported by COM vs GCA (11% vs 1%, p=0.01). Headache was the most frequently reported symptom in both groups. Patients with GCA reported jaw claudication (37%) as the second most frequently reported symptom, while COM reported arthralgia/arthritis (32%). Shoulder/neck pain was the third most important symptom in GCA (33%), while fatigue was the third most common complaint among COM (21%). Fatigue was reported as the fourth most common feature by 30% of GCA patients.Table 1.Top 10 most recurrent patient-reported symptoms and correspondent severity rank in giant cell arteritis (GCA) and Comparators (COM)ItemFrequency in GCASeverity in GCAFrequency in COMSeverity in COMExamples of patient's own words Headache11, 2, 811, 2, 5Headaches; Sore head; Thumping headacheJaw claudication23, 660Jaw ache; Pain in jaw and teethShoulder/neck pain33, 4, 5,00Shoulder upper arm painFatigue45, 6, 1033, 6, 7Severe tiredness; Fatigue; No energy and exhaustedMyalgia or muscle weakness55, 7, 1043Aching muscles; Achey limbs; Loss of strength in arms and legsBlurred vision61054, 8Blurred visionScalp tenderness7804Irritation to the scalp; Tender scalpLoss of appetite800Lack of appetiteFlu-like symptoms9900General ill feeling; Flu-like symptoms; UnwellArthralgia or arthritis10923Hip, knee more on right side; Pain in back of neck, ankles, wrists, and chestOther ENT0074Severe sinusitis; sore inside gumsSudden visual loss008Loss of eyesight to both eyes; Vision lossNight sweats0094, 8Night sweats; Night fever sweatsPainful eyes09100Shooting pain left eye; Pain right eyeConclusionsHeadache was the most frequent and most severe symptom reported by patients with GCA and compara...

No abstract