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[Intestinal infarct caused by giant cell arteritis].
V Kalbermatter1, C Laudanno, D Bagilet
1Servicio de Clínica Médica, Reumatología y Clínica Quirúrgica, Sanatorio Delta, Rosario, Argentina. sdelta@infovia.com.ar
Medicina
|June 1, 1999
Summary
Giant cell arteritis is a rare cause of intestinal infarction. This case highlights the importance of considering this condition in elderly patients with abdominal pain and elevated inflammatory markers, even with normal initial imaging.
Area of Science:
- Vascular Medicine
- Gastroenterology
- Rheumatology
Background:
- Giant cell arteritis (GCA) typically affects cranial arteries but can involve extracranial and visceral vessels.
- Intestinal involvement in GCA is uncommon, often leading to delayed diagnosis and potential complications like infarction.
- Diagnosis of GCA is frequently retrospective, based on pathological findings of surgical specimens.
Observation:
- An 83-year-old woman presented with acute fever and left-sided abdominal pain.
- Initial investigations suggested acute diverticulitis, but conservative treatment failed.
- Abdominal tomography revealed peritoneal thickening and fluid, prompting surgical exploration.
Findings:
- Surgical findings indicated colonic infarction, necessitating resection.
- Pathological examination confirmed arterial thrombosis secondary to giant cell arteritis as the cause of infarction.
- Despite normal temporal artery biopsy and immunological studies, the diagnosis of GCA was established.
Implications:
- This case underscores the need to consider GCA in the differential diagnosis of abdominal emergencies in the elderly.
- Prompt diagnosis and treatment with corticosteroids (e.g., prednisone) can lead to rapid clinical improvement.
- Highlights the diagnostic challenges of GCA when it presents with atypical symptoms and normal initial non-invasive tests.