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Giant cell arteritis associated with pericarditis and large vessel disease
D Stanley1, D Henderson, S Harris
1Queen Elizabeth Hospital, Adelaide, SA.
Insights
Giant cell arteritis can affect aortic branches, causing difficult-to-diagnose symptoms like limb ischemia and pericarditis. Despite corticosteroid treatment, the patient experienced fatal bowel infarction, highlighting diagnostic challenges.
Area of Science:
- Vascular Surgery
- Rheumatology
- Internal Medicine
Background:
- Giant cell arteritis (GCA) commonly affects external carotid artery branches and causes systemic symptoms.
- However, GCA can also involve aortic branches, leading to complex clinical presentations.
- These aortic involvements present diagnostic challenges in clinical practice.
Observation:
- A case of GCA presenting with limb ischemia, pericarditis, and systemic symptoms is described.
- The patient's symptoms included peripheral vascular disease and cardiac inflammation.
- Systemic manifestations were observed alongside ischemic complications.
Findings:
- Corticosteroid therapy improved systemic symptoms of GCA.
- Ischemic manifestations, including limb ischemia, were refractory to corticosteroid treatment.
- The patient ultimately succumbed to bowel infarction four months post-treatment initiation.
Implications:
- This case underscores the potential for GCA to cause severe ischemic complications beyond typical cranial artery involvement.
- It highlights the diagnostic difficulties associated with GCA affecting the aorta and its branches.
- The findings suggest a need for heightened awareness and potentially different therapeutic strategies for GCA-induced large vessel vasculitis.
Abstract:
Giant cell arteritis is well recognised to affect branches of the external carotid artery and to cause systemic symptoms, but may also involve branches of the aorta producing a clinical syndrome that may be difficult to diagnose. A patient is described who presented with limb ischaemia, pericarditis and systemic symptoms. Treatment with corticosteroids improved the systemic manifestations but not the ischaemia. The patient died of bowel infarction four months after treatment was commenced.