[Giant cell arteritis revealed by scalp necrosis]

Area of Science:

• Vascular Surgery
• Dermatology
• Rheumatology

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting medium and large arteries.
• Scalp necrosis is an infrequent but severe complication of GCA, potentially leading to significant tissue loss.
• Early recognition and management are crucial for preventing complications.

Observation:

• A 78-year-old female patient presented with extensive scalp necrosis.
• The necrosis involved full-thickness scalp, epicranium, and the outer table of the skull, forming a 7 x 4 cm defect.
• The patient had a confirmed diagnosis of GCA.

Findings:

• The therapeutic strategy involved corticotherapy, anticoagulation, and meticulous wound care.
• Despite treatment, the patient developed severe wound infection, including osteitis and a subgaleal abscess, necessitating prolonged antibiotic therapy.
• A conservative approach achieved healing by second intention, with observed neovascularization and bone resorption during the recovery process.

Implications:

• This case underscores the importance of considering GCA in patients presenting with unexplained scalp necrosis.
• Conservative wound management can be effective in achieving healing even in cases with deep tissue involvement and infection.
• The observed neovascularization and bone resorption suggest the body's capacity for repair even in compromised tissue.