A subcutaneous fluid collection after the Bentall procedure in a female patient with giant cell arteritis

Abstract We report a 61-year-old woman with a history of untreated inflammatory symptoms, who underwent a Bentall procedure for a rapidly evolving aneurysm. Postoperatively, she presented with a sub-sternal pulsatile mass communicating with a periaortic collection. After excluding surgical and infectious complications, an inflammatory seroma due to an uncontrolled vasculitis was suspected. We proposed a non-surgical approach involving immunosuppressive therapy.

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Fatal Aortic Dissection in a Patient with Giant Cell Arteritis: A Case Report and Review of the Literature

Case Reports in Vascular Medicine ◽

10.1155/2013/590721 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Anjeli K. Nayar ◽

Michael Casciello ◽

Jennifer N. Slim ◽

Ahmad M. Slim

Keyword(s):

Aortic Dissection ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Temporal Arteritis ◽

Acute Aortic Dissection ◽

Vascular Wall ◽

Clinical Implications ◽

Review Of The Literature ◽

History Of ◽

Prompt Diagnosis

Giant cell arteritis may lead to catastrophic, large-vessel complications from chronic vascular wall inflammation without prompt diagnosis and treatment. We describe a rare case of acute aortic dissection without preceding aneurysm secondary to histologically confirmed giant cell arteritis (GCA) in an 85-year-old female with a four-year history of polymyalgia rheumatica and temporal arteritis diagnosed per biopsy six months prior to presentation. The literature is reviewed and the clinical implications of this case are discussed.

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Lethal giant cell arteritis with multiple ischemic strokes despite aggressive immunosuppressive therapy

Journal of the Neurological Sciences ◽

10.1016/j.jns.2010.05.008 ◽

2010 ◽

Vol 295 (1-2) ◽

pp. 120-124 ◽

Cited By ~ 7

Author(s):

Christine Lu-Emerson ◽

Melanie Walker ◽

Bertrand R. Huber ◽

Basavaraj Ghodke ◽

W.T. Longstreth, ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Immunosuppressive Therapy ◽

Giant Cell

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Hypertrophic pachymeningoencephalitis associated with temporal giant cell arteritis

BMJ Case Reports ◽

10.1136/bcr-2018-225304 ◽

2018 ◽

pp. bcr-2018-225304

Author(s):

Gesine Boisch ◽

Sven Duda ◽

Christian Hartmann ◽

Heinrich Weßling

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Temporal Arteritis ◽

Brain Mri ◽

Neurological Deficits ◽

High Dose ◽

Immunoglobulin G4 ◽

Perifocal Oedema ◽

History Of ◽

Dose Corticosteroid

We report the rare case of an 80-year-old male patient with hypertrophic pachymeningoencephalitis that may be associated with temporal arteritis. The patient presented to our neurological department with a 2-week history of latent paresis and ataxia affecting his right hand. He had been diagnosed with temporal arteritis 12 years earlier. Brain MRI showed an enhancement of the left-sided frontoparietal meninges with oedema of the adjacent tissue of the precentral and postcentral cortex. A leptomeningeal biopsy was performed. An autoimmune-mediated immunoglobulin G4-associated hypertrophic pachymeningoencephalitis was diagnosed. The patient received a high-dose corticosteroid therapy and his symptoms gradually improved. Our results suggest that hypertrophic pachymeningoencephalitis may occur as a complication of giant cell arteritis and may cause central neurological deficits by cerebral perifocal oedema.

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Vulvar Hemangioma: Case Report

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1657786 ◽

2018 ◽

Vol 40 (06) ◽

pp. 369-371

Author(s):

Janine Silva ◽

Emily Calife ◽

João Cabral ◽

Hildemárzio Andrade ◽

Ana Gonçalves

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Female Patient ◽

Surgical Approach ◽

Benign Neoplasm ◽

Surgical Excision ◽

Genital Ulcer ◽

Emotional Disability ◽

The Past ◽

History Of

AbstractHemangioma is a benign neoplasm that may affect the vulva, and it can cause functional or emotional disability. This article reports the case of a 52-year-old female patient with a history of a genital ulcer for the past 3 years and who had undergone various treatments with creams and ointments. The patient was biopsied and diagnosed with vulvar hemangioma and was subsequently submitted to surgical excision of the lesion. We emphasize the importance of following the steps of the differential diagnosis and proceeding with a surgical approach only if necessary.

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Progressive and Fatal Brainstem Stroke in Systemic Giant Cell Arteritis

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001083 ◽

2021 ◽

pp. 10.1212/CPJ.0000000000001083

Author(s):

Valentina Poretto ◽

Silvio Piffer ◽

Valeria Bignamini ◽

Enzo Tranquillini ◽

Davide Donner ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Temporal Artery ◽

Facial Artery ◽

High Dose ◽

Temporal Artery Biopsy ◽

Halo Sign ◽

Pet Ct ◽

Brainstem Stroke ◽

History Of

A 74-year-old woman presented with acute worsening of six-months long history of vertigo and postural instability, with MRI evidence of cerebellar and brainstem acute infarcts. Extensive neurovascular assessment revealed a severe vascular damage with multiple stenoses and occlusions along vertebrobasilar axis (figure 1). Duplex ultrasonography showed hypoechoic halo sign along facial artery, while PET-CT highlighted increased [18F]-FDG uptake along vertebral and other larger arteries, thus allowing a diagnosis of giant cell arteritis (figure 2).1,2 Despite prompt treatment with high-dose steroids and tocilizumab, which probably made uninformative a subsequent temporal artery biopsy (figure 2), patient died of reported disability after strokes.

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Supraclavicular pulsatile mass as presenting sign of brachiocephalic trunk aneurysm in the long-term followup of giant cell arteritis

Arthritis & Rheumatism ◽

10.1002/art.21163 ◽

2005 ◽

Vol 53 (3) ◽

pp. 475-476 ◽

Cited By ~ 6

Author(s):

Carlos Garcia-Porrua ◽

Robustiano Pego-Reigosa ◽

Angela Piñeiro ◽

Victor Armesto ◽

Miguel A. González-Gay

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Pulsatile Mass ◽

Brachiocephalic Trunk

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Immunosuppressive Therapy (Methotrexate or Cyclophosphamide) in Combination with Corticosteroids in the Treatment of Giant Cell Arteritis: Comparison with Corticosteroids Alone

Journal of the American Geriatrics Society ◽

10.1111/jgs.14004 ◽

2016 ◽

Vol 64 (3) ◽

pp. 672-374 ◽

Cited By ~ 3

Author(s):

Angela Carbonella ◽

Giorgia Berardi ◽

Luca Petricca ◽

Federico Biscetti ◽

Stefano Alivernini ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Immunosuppressive Therapy ◽

Giant Cell ◽

Therapy Methotrexate

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AB0501 THREE CASES OF VERTEBRAL ARTERITIS IDENTIFIED ON FDG-PET IN PATIENTS WITH SUSPECTED GCA AT UNIVERSITY COLLEGE LONDON HOSPITAL (UCLH)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.410 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1549.2-1549

Author(s):

D. Ludwig ◽

M. Naja ◽

S. Voo ◽

V. Morris

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Pet Imaging ◽

Fdg Pet ◽

Immunosuppressive Treatment ◽

Temporal Artery ◽

Large Vessel ◽

Diagnostic Tools ◽

History Of ◽

Vessel Involvement

Background:Giant cell arteritis (GCA) may affect both cranial and extra-cranial vessels; where the latter occurs, it can be termed large-vessel GCA (LV-GCA). Large vessel involvement is common: histological evidence has been seen in 80% of autopsies of patients with known GCA, and imaging studies suggest large vessel involvement in over 80%1. LV-GCA is important to diagnose due to the risks of vascular complications such as occlusion and ischaemic stroke. The clinical diagnosis can be challenging, and the American College of Rheumatology (ACR) GCA classification criteria often underperform in cases of LV-GCA1. F-fluorodeoxyglucose positron emission tomography (FDG-PET) has been found to be useful in the detection of extra-cranial involvement to support the diagnosis of LV-GCA.2Objectives:To appreciate the variability in presentation of cases of LV-GCA, and to further characterise a subgroup of patients with vertebral arteritis.To explore the use of FDG-PET imaging in GCA patients in addition to or in place of traditional diagnostic tools (temporal artery ultrasound / biopsy).Methods:Through evaluation of the new GCA fast-track pathway implemented at UCLH, a subgroup of patients diagnosed with vertebral arteritis was identified. The history and presentation of these patients were analysed.Results:Three patients were diagnosed with vertebral arteritis. All three were male, Caucasian and aged over 70. All were investigated for GCA due to a history of severe headache (frontal in one, occipital in one, bi-temporal in one) with associated red flag symptoms. Two had a history of jaw claudication and visual disturbances (unilateral visual loss in one, transient diplopia in the other). Both of these patients had positive temporal artery biopsies. The third patient had no ischaemic symptoms but a strong history of prominent polymyalgic features and a positive temporal artery ultrasound. Inflammatory markers were raised in two, and normal in one, of the patients. Only one had systemic symptoms (weight loss). All three proceeded to FDG-PET scans which showed vertebral arteritis and were commenced on immunosuppressive treatment.Conclusion:The cases discussed illustrate the heterogeneity of the presentation of LV-GCA, and the diagnostic challenge this poses. FDG-PET imaging is useful in confirming extra-cranial involvement and therefore guiding treatment.References:[1]Large-vessel giant cell arteritis: diagnosis, monitoring and management.Matthew J Koster, Eric L Matteson, Kenneth J Warrington.2018, Rheumatology, Vol. 57, pp. 32-42.[2]EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice.Dejaco C, Ramiro S, Duftner C, et al.2018, Annals of the Rheumatic Diseases, Vol. 77, pp. 636-643.Disclosure of Interests: :None declared

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Risk Factors for Permanent Visual Loss in Biopsy-proven Giant Cell Arteritis: A Study of 339 Patients

The Journal of Rheumatology ◽

10.3899/jrheum.151135 ◽

2016 ◽

Vol 43 (7) ◽

pp. 1393-1399 ◽

Cited By ~ 26

Author(s):

Eric Liozon ◽

François Dalmay ◽

Fabrice Lalloue ◽

Guillaume Gondran ◽

Holy Bezanahary ◽

...

Keyword(s):

Risk Factors ◽

Giant Cell Arteritis ◽

Giant Cell ◽

Visual Loss ◽

Clinical Findings ◽

Multivariable Logistic Regression Analysis ◽

Glucocorticoid Treatment ◽

Increased Risk ◽

History Of ◽

Laboratory Variables

Objective.To determine the risk factors for permanent visual loss (PVL) in patients with biopsy-proven giant cell arteritis (GCA) and the usefulness of the factors in clinical practice.Methods.From 1976 through 2015, the clinical charts and laboratory results of 339 patients with biopsy-proven GCA were recorded prospectively at the time of diagnosis. We used multivariable logistic regression analysis to determine which of 24 pretreatment characteristics were associated with PVL.Results.Visual ischemic manifestations occurred in 108 patients, including PVL in 53 (16%), bilaterally in 15 patients (28%). The independent predictors associated with an increased risk of PVL were age (OR 1.06, 95% CI 1.01–1.12, p = 0.01), a history of transient visual ischemic symptoms (OR 2.62, 95% CI 1.29–5.29, p < 0.01), and jaw claudication (OR 2.11, 95% CI 1.09–4.10, p = 0.03). The presence of fever (OR 0.30, 95% CI 0.14–0.64, p < 0.01) and rheumatic symptoms (OR 0.23, 95% CI 0.10–0.57, p = 0.001) were associated with a markedly reduced risk of developing visual loss (3.7% if features were both present). No laboratory variables were independently associated with PVL.Conclusion.The visual ischemic risk of untreated GCA can be readily estimated upon simple clinical findings, but not laboratory variables. However, we did not identify a subgroup of patients carrying no risk of developing visual loss. Glucocorticoid treatment remains, therefore, urgent for any patient with a high clinical suspicion index.

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