Giant cell arteritis presenting as facial swelling.

Area of Science:

• Rheumatology
• Vascular Medicine
• Internal Medicine

Background:

• Temporal arteritis (TA), typically diagnosed in individuals over 50, often presents with vague symptoms like headaches and polymyalgia rheumatica.
• Facial swelling is an underrecognized but significant presentation of TA.

Observation:

• Nonspecific symptoms such as headache, polymyalgia rheumatica, and fever are common in TA.
• Facial swelling, particularly when accompanied by other subtle symptoms, should raise clinical suspicion for TA.

Findings:

• Prompt diagnosis of TA, confirmed by temporal artery biopsy, is essential to prevent serious vascular events including blindness and stroke.
• Corticosteroid therapy is the primary treatment, though high-dose and prolonged use carry risks.

Implications:

• Recognizing facial swelling as a TA symptom can lead to earlier diagnosis and intervention.
• Timely temporal artery biopsy is critical for confirming TA diagnosis and guiding treatment, even after initiating corticosteroids.
• Low-dose aspirin may offer a promising adjunctive therapy for TA.