Giant cell arteritis of the skin simulating erythema nodosum.

Abstract

SUMMARY Cutaneous involvement in giant cell arteritis is quite uncommon. A patient is described who presented with pretibial skin lesions clinically indistinguishable from erythema nodosum which, on biopsy, showed subcutaneous pannicular giant cell vasculitis. Cutaneous manifestations of giant cell arteritis are subsequently reviewed.

Supraorbital nodule biopsy leading to the diagnosis of giant cell arteritis

“…described a case in which giant cell arteritis presented as a supraclavicular nodule which appeared clinically to be a lymph node 2 . Other masquerade manifestations include breast masses 3 and lower extremity nodules simulating erythema nodosum 4 …”

Extracranial cutaneous manifestation of temporal arteritis – a case of erythematous plaques on the legs

“…Our patient developed painful plaques on the legs as systemic manifestation of temporal arteritis. There has only been one clinically similar case in the literature, describing a 61-year-old woman with pretibial nodules that resembled erythema nodosum [3]. She had no classic symptoms of temporal arteritis but claudication of the lower extremities for four months.…”

Pathology of the Cutaneous Vasculitides: A Comprehensive Review

“…Clinical symptoms are usually due to ischemia secondary to endarteritis obliterans and include headache, jaw cladication, and visual and neurological problems (Carlson & Chen, 2007). Timely diagnosis is imperative since significant morbidity, including visual loss, and even death may occur if treatment is delayed (Goldberg et al, 1987). Cutaneous findings in GCA are rare, presenting in less than 1% of cases, and include scalp tenderness, loss or decrease in temporal pulse, scalp necrosis, and scalp blanching (Chen & Carlson, 2008).…”

“…Cutaneous findings in GCA are rare, presenting in less than 1% of cases, and include scalp tenderness, loss or decrease in temporal pulse, scalp necrosis, and scalp blanching (Chen & Carlson, 2008). Erythema, ecchymoses, purpura, ulceration, gangrene, urticaria, erythema nodosum, and hyperpigmentation on the lower extremities have also been reported (Goldberg et al, 1987). Scalp necrosis is associated with increased risk of vision loss and carries a higher mortality rate (Tsianakas et al, 2009).…”

“…Scalp necrosis is associated with increased risk of vision loss and carries a higher mortality rate (Tsianakas et al, 2009). The diagnostic features of GCA on temporal artery biopsy are segmental inflammation of the artery and infiltration of the media, adventitia, and internal elastic lamina by lymphocytes, neutrophils, and multinucleated giant cells (see Figures 17 and 18) (Goldberg et al, 1987). The segmental arterial involvement makes histologic diagnosis a challenge.…”