Giant Cell Arteritis: An Atypical Presentation Diagnosed with the Use of MRI Imaging

Abstract

Giant cell arteritis (GCA) is the most common primary systemic vasculitis in western countries in individuals over the age of 50. It is typically characterised by the granulomatous involvement of large and medium sized blood vessels branching of the aorta with particular tendencies for involving the extracranial branches of the carotid artery. Generally the diagnosis is straightforward when characteristic symptoms such as headache, jaw claudication, or other ischemic complications are present. Atypical presentations of GCA without “overt” cranial ischemic manifestations have become increasingly recognised but we report for the first time a case of GCA presenting as mild upper abdominal pain and generalized weakness in the context of hyponatremia as the presenting manifestation of vasculitis that was subsequently diagnosed by MRI scanning. This case adds to the literature and emphasises the importance of MRI in the evaluation of GCA patients without “classic” cranial ischemic symptoms.

Vasculitis with granulomatosis: An atypical presentation of giant cell arteritis

“…Giant cell arteritis (GCA) is a large- and medium-vessel granulomatous vasculitis that affects the aorta and its major branches, particularly the extracranial branches of the carotid artery. 1 , 2 , 3 GCA occurs primarily in those over 50 years of age and classically manifests as fevers, malaise, headaches, a temporal artery abnormality, jaw claudication, and visual disturbance. 1 The American College of Rheumatology criteria for the diagnosis of GCA require at least 3 of the following: age >50 years, new-onset headaches, temporal artery tenderness, an erythrocyte sedimentation rate of ≥50 mm/hour, and an arterial biopsy demonstrating vasculitis with a mononuclear cell infiltrate or granulomatous inflammation.…”

A Case of Temporal Arteritis Associated with Atypical Clinical Findings

“…Papakostas et al [13] reported a case of GCA that presented with cotton wool spots and retinal vasculitis affecting small-size retinal arterioles. Shambhu et al [14] reported an atypical case of GCA presenting as mild upper abdominal pain and generalized weakness in the context of hyponatremia as the presenting manifestation of vasculitis that was subsequently diagnosed by MRI scanning. Cheema et al [15] described a case had the signs and symptoms consistent with GCA but who had an ESR within the normal limits, 27mm/h.…”