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[Horton's bitemporal arteritis. A case report]
G Carmenini1, S Martusciello, F Di Maio
1Instituto di I Clinica medica, Università La Sapienza, Roma.
Insights
This case study highlights unusual Horton's arteritis symptoms, including jaw claudication and worsening extrapyramidal signs. Early diagnosis and low-dose cortisone treatment led to rapid symptom improvement.
Area of Science:
- Neurology
- Rheumatology
- Vascular Medicine
Background:
- Horton's arteritis, a large vessel vasculitis, typically affects the temporal arteries.
- Giant cell arteritis can present with diverse neurological and vascular complications.
- Standard treatment involves high-dose corticosteroids, often for extended periods.
Observation:
- A 76-year-old woman presented with simultaneous superficial temporal arteritis, bilateral jaw claudication, and exacerbated extrapyramidal symptoms.
- Histopathology of temporal artery biopsy showed typical signs of arteritis but lacked giant cells, possibly due to prior NSAID use.
- The patient experienced rapid symptom regression and normalized laboratory tests with low-dose oral cortisone therapy.
Findings:
- The case demonstrates an atypical presentation of Horton's arteritis with simultaneous bilateral temporal artery involvement and neurological complications.
- The absence of giant cells in the biopsy, despite typical arteritis, suggests potential confounding factors like NSAID therapy.
- Successful treatment with low-dose corticosteroids contrasts with the reported resistance to cortisone therapy in many Horton's arteritis cases.
Implications:
- Early diagnosis and prompt intervention, even with atypical presentations, may significantly alter the disease's course.
- This case suggests that low-dose corticosteroid therapy might be effective in specific Horton's arteritis presentations.
- Further research is warranted to explore the impact of prior NSAID use on temporal artery biopsy findings and treatment response in Horton's arteritis.
Abstract:
The authors report a case of Horton's arteritis in a woman (aged 76) presented some peculiarities. The arteritis simultaneously interested both superficial temporal arteries; in a second time caused a bilateral "claudicatio masticationis"; induced a worsening of extrapyramidal symptoms from which the patient had been suffering for many years, due to the possible involvement also of the endocranial arteries. The histologic picture on a biopsy of the left temporal artery was typical of the Horton's disease, but without giant cells; the authors suppose that this is due to a therapy with FANS administered before carrying out the biopsy. The patient was treated with cortisone per os at a low dosage, causing a quick regression of the symptoms and a normalization of the laboratory tests. Also this result differs from what most authors have observed: they maintain that Horton's arteritis has become rather resistant to the cortisone therapy and required high dosage for a very long time. The authors maintain that precocity of diagnosis and an immediate treatment can influence in a significant way the course of the disease.