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Bilateral scalp necrosis with giant cell arteritis
Midori Matsushima1, Keiichi Yamanaka, Hitoshi Mori
1Department of Dermatology, Mie University, Faculty of Medicine, Tsu, Japan.
The Journal of Dermatology
|April 15, 2003
Summary
Giant cell arteritis caused bilateral scalp necrosis in a patient. Prompt treatment with increased prednisolone and limaprost alphadex led to ulcer reepithelialization without surgery.
Area of Science:
- Rheumatology
- Vascular Surgery
Background:
- Giant cell arteritis (GCA), also known as temporal arteritis, is a systemic vasculitis primarily affecting medium and large arteries.
- Polymyalgia rheumatica (PMR) is often associated with GCA, typically treated with low-dose corticosteroids.
Observation:
- A 67-year-old woman with PMR on alternate-day prednisolone developed bilateral, painful, necrotic scalp lesions.
- Clinical examination revealed bilateral temporal artery obstruction, confirmed by biopsy showing ischemic necrosis and arteritis with giant cells.
- Angiography demonstrated bilateral internal carotid artery stenosis and retinal hemorrhages.
Findings:
- The patient presented with bilateral scalp necrosis, a rare manifestation of GCA.
- Histopathology confirmed ischemic necrosis and necrotizing angiitis of temporal arteries.
- Vascular imaging revealed significant stenosis in internal carotid arteries and retinal bleeding.
Implications:
- This case highlights the potential for severe ischemic complications, including bilateral scalp necrosis, in GCA patients.
- Aggressive immunosuppression and vascular treatments may be crucial for managing GCA-related ischemic events.
- Prompt diagnosis and intervention are essential to prevent irreversible tissue damage and vision loss.