Lumbosacral radiculopathy as a rare manifestation of giant cell arteritis: A case report and review of the literature.

Abstract

Giant cell arteritis (GCA) is the most common form of primary vasculitis, affecting primarily the large and middle sized arteries in people aged 50 years or older. It is associated with a spectrum of neurological manifestations, the most frequent being neuro-ophtalmic, others are mononeuritis simplex, mononeuritis multiplex, diffuse peripheral polyneuropathy, acute confusional states, spinal cord infarction and TIA/stroke. Radiculopathy/plexopathy is rarely described.This report present a case with lumbosacral radiculopathy, perceived as steroid-induced myopathy. Abstract Case HistoryA 84-year old female with polymyalgia rheumatica (PMR) with disease onset at the age of 62 and with ongoing prednisolone (PRD) 12.5 mg/d, was referred to the rheumatology department in December 2012 due to progressive proximal muscle weakness of the lower extremities over the last 2 years, considered as steroid-induced myopathy.At disease onset September 1991, the patient suffered acute onset of pains in the calf muscles and shortly after also pains in the neck and upper arms, erythrocyte sedimentation rate (ESR) was 90 mm/1 h, no other laboratory measurements was done. PMR was diagnosed by her general practitioner and PRD was instituted with a prompt response. PRD was then tapered during one year to 5 mg/d when she flared leading to escalation to 15-20 mg/d. This pattern was repeated again and again over the years. She managed to become PRD free once for three years before a relapse of PMR symptoms and PRD was re-established. Neither at disease onset nor later did she display any ischemic symptoms.

Zoledronate-Induced Large Vessel Vasculitis Diagnosed by PET/CT

“…However, there are extremely rare side effects such as LVV [1]. Two such LVV cases have been previously reported in the literature [3,4]. We report the first case of LVV secondary to zoledronic acid infusion in Russia.…”

“…The most-common side effects are post-dose fever, flu-like symptoms, myalgia, arthralgia, and headache, which usually occur in the first 3 days after infusion and are self-limited [5]. Rare adverse events of long-term zoledronate therapy include osteonecrosis of the jaw, atypical femoral fracture, renal dysfunction, hypocalcemia, symptomatic atrial fibrillation, uveitis, and episcleritis [4].…”