Unusual manifestations of giant cell arteritis: pulmonary nodules, cough, conjunctivitis and otitis with deafness

Zénone, Thierry; Pj, Souquet; Bohas, C.; Durand, D. Vital; Jp, Bernard

doi:10.1183/09031936.94.07122252

Cited by 30 publications

(8 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…GCA carries a broad range of presentation. Cases of GCA affecting different CNs have been reported before and include unilateral abducens nerve [ 11 ], bilateral abducens nerve [ 12 ], unilateral abducens with oculomotor nerve palsy [ 3 ], isolated eighth CN palsy [ 13 - 15 ], and eighth CN involvement with cough, conjunctivitis, and pulmonary nodules [ 16 ]. There were also cases of left recurrent laryngeal palsy with aortic arch aneurysm [ 17 - 18 ], hoarseness of voice [ 19 - 20 ] and simultaneous involvement of three CNs [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Temporal Arteritis Presenting as an Isolated Bilateral Abducens Nerve Palsy: A Rare Case of a 65-year-old Male

Lunagariya¹,

Rupareliya²,

Bollu³

et al. 2018

Cureus

View full text Add to dashboard Cite

Giant cell arteritis (GCA) or temporal arteritis (TA) is a granulomatous inflammation of medium to large-sized arteries. It may have a diverse presentation. The most common presenting symptoms of GCA are fever, malaise, unilateral headache, jaw claudication, polymyalgia rheumatica (PMR) and ophthalmoplegia. Most severe sequelae of GCA could be blindness. We report a case of a 65-year-old Caucasian male who presented for the third time with recurrent episodes of diplopia. Neurologic exam showed bilateral cranial nerve (CN) VI palsy, slightly worse on the right than the left side. Other focal neurological deficits were absent. GCA was considered and biopsy of the temporal artery was performed which showed necrotizing pan-arteritis, consistent with GCA. The patient was empirically treated with intravenous (IV) methylprednisolone while awaiting the biopsy results which resulted in the resolution of the symptoms. As far as we know, this is the second case in the literature about the bilateral sixth CN involvement in the background of GCA.

show abstract

Section: Discussionmentioning

confidence: 99%

Temporal Arteritis Presenting as an Isolated Bilateral Abducens Nerve Palsy: A Rare Case of a 65-year-old Male

Lunagariya¹,

Rupareliya²,

Bollu³

et al. 2018

Cureus

View full text Add to dashboard Cite

show abstract

“…There have been several case reports of patients concomitantly presenting with clinical features of different types of vasculitides. Here, we described a patient who presented with GCA and GPA, identified similar patients in the literature [ 1 – 10 ], and abstracted data on the clinical features of such co-presentations. Some authors use the term polyangiitis overlap syndrome to describe systemic vasculitis that does not fit into a single diagnostic category but has aspects from several categories of vasculitides [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Co-Presentation of Giant Cell Arteritis and Granulomatosis with Polyangiitis: A Case Report and Review of Literature

et al. 2018

View full text Add to dashboard Cite

Patient: Female, 67Final Diagnosis: GPA and GCASymptoms: Blurry vision • headache • nosebleed • sinus congestionMedication: —Clinical Procedure: —Specialty: RheumatologyObjective:Rare co-existance of disease or pathologyBackground:Systemic vasculitis can present with a multitude of symptoms involving multiple organ systems. Clinicians should avoid anchoring bias and be cognizant that different types of vasculitides can be present in the same patient and that the diagnosis of one should not preclude the subsequent diagnosis of another.Case Report:A 67-year-old woman was referred for evaluation of episodes of epistaxis and recurrent severe sinusitis. Her physical examination showed nasal congestion and purpuric rash on the lower extremities. CT of the sinuses showed severe mucosal thickening. ANCA serologies were positive with a c-ANCA titer of 1: 5120 and anti-proteinase-3 (anti-PR3) antibodies of 1061 units. Serum creatinine was elevated at 1.32 mg/dL (GFR of 40.62 ml/min). Urine analysis showed proteinuria and hematuria. The patient declined treatment initially, but while awaiting kidney biopsy she developed episodes of headache and blurry vision. She underwent right temporal artery biopsy 4 days later, which confirmed the diagnosis of GCA. The biopsy showed characteristic histopathology findings and she was started on 60 mg of prednisone daily. The kidney biopsy showed pauci-immune crescentic glomerulonephritis (PICGN) consistent with ANCA-associated vasculitis. We identified all the cases of co-presentation of GCA and GPA in the literature and summarized their clinical features in this report.Conclusions:Astute clinicians should be cognizant of overlapping and atypical presentations of vasculitides to avoid delayed diagnosis and errors in management.

show abstract

“…D'autres manifestations atypiques de l'ACG ont été décrites dans la littérature : claudication des bras et phénomène de Raynaud, anévrisme/dissection de l'aorte thoracique ou insuffisance aortique [4,5], atteintes respiratoires et oto-rhynolaryngologiques (toux sèche, épanchement pleural, infiltrat/ nodule pulmonaire, oedème laryngé…) [4,5,14,15]. Des atteintes neurologiques sont possibles, soit périphériques (mononévrite/multinévrite) ou radiculaires, soit centrales (vertiges-surdité, troubles du goût et de l'odorat, paralysie …”

Section: Fig 4a Histological Analysis Of the Right Temporal Artery unclassified

Manifestations atypiques de l’artérite à cellules géantes : un défi pour le chirurgien-dentiste. Cas clinique et revue de la littérature

Radoï

Renoux

2016

Med Buccale Chir Buccale

View full text Add to dashboard Cite

Résumé -Introduction : L'artérite à cellules géantes (ACG) est une pathologie inflammatoire chronique vasculaire affectant le patient à partir de la 5 ème décennie. Le tableau clinique, très varié et parfois atypique, peut induire des erreurs diagnostiques avec de lourdes conséquences. Observation : Une patiente de 63 ans s'était présentée à la consultation de chirurgie buccale après une errance diagnostique pour des douleurs cervicales postérieures et occipitales, irradiant ensuite au maxillaire droit, interprétées initialement comme d'origine dentaire. Le tableau clinique, réétudié lors de la consultation, montrait des modifications de l'artère temporale superficielle faisant suspecter une ACG. La patiente fut directement orientée vers le service de rhumatologie pour la confirmation du diagnostic et la prise en charge immédiate. Discussion : Les manifestations de l'ACG sont le reflet de l'atteinte de nombreuses artères issues de l'arc aortique, responsable de tableaux cliniques très variés. Les conséquences graves à court terme de cette affection (cécité irréversible, accident vasculaire cérébral) imposent une prise en charge urgente et efficace par une corticothérapie systémique. Conclusion : La diversité des manifestations de l'ACG peut conduire le patient à consulter en premier lieu le chirurgien-dentiste qui doit savoir inclure cette pathologie dans les diagnostics différentiels des douleurs oro-faciales et adresser rapidement le patient. Abstract -Atypical manifestations of giant cell arteritis: Case report and literature review. Introduction:Giant cell arteritis (GCA) is a vasculitis commonly affecting patients after the fifth decade. Atypical clinical manifestations can induce a wrong diagnosis that can lead to dramatic damages. Observation: A 63-year-old woman had been sent to oral surgery department for maxillary pain, after being seen by a dentist and an endodontist: a dental origin had wrongly been suspected. Besides several symptoms (orofacial pain, asthenia, anorexia), clinical abnormalities of the right temporal artery evoked the diagnosis of GCA. She had been sent quickly to the rheumatology service for confirmation of the diagnosis and special care. Discussion: Inflammation of branches of aortic artery lead to several clinical manifestations, resulting sometimes in atypical expressions. The potentially severe consequences of the disease (irreversible blindness, ischemic stroke) compel an immediate corticosteroid therapy. Conclusion: The large variety of clinical manifestations of the GCA has to be known by the dental surgeon, to be able to identify atypical symptoms and to send his patient as soon as possible to the specialist.

show abstract

Unusual manifestations of giant cell arteritis: pulmonary nodules, cough, conjunctivitis and otitis with deafness

Cited by 30 publications

References 7 publications

Temporal Arteritis Presenting as an Isolated Bilateral Abducens Nerve Palsy: A Rare Case of a 65-year-old Male

Temporal Arteritis Presenting as an Isolated Bilateral Abducens Nerve Palsy: A Rare Case of a 65-year-old Male

Co-Presentation of Giant Cell Arteritis and Granulomatosis with Polyangiitis: A Case Report and Review of Literature

Manifestations atypiques de l’artérite à cellules géantes : un défi pour le chirurgien-dentiste. Cas clinique et revue de la littérature

Contact Info

Product

Resources

About