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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.

Recenti Progressi in Medicina
|October 1, 1992
PubMed
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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.

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  • 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.