Isolated superficial temporal artery dissection masquerading as giant cell arteritis

Area of Science:

• Vascular Surgery
• Rheumatology
• Neurology

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis often affecting the superficial temporal artery (STA).
• Diagnosis typically involves clinical suspicion and elevated inflammatory markers, confirmed by biopsy.
• STA involvement in GCA can lead to serious complications like vision loss.

Observation:

• A 79-year-old male presented with symptoms suggestive of GCA and elevated acute-phase reactants.
• Bilateral STA biopsies were performed to evaluate for GCA.
• The left STA biopsy was negative for GCA, but the right STA biopsy revealed dissection.

Findings:

• The patient's presentation mimicked GCA, but histopathology confirmed spontaneous isolated STA dissection.
• Spontaneous isolated dissection of the STA is an exceedingly rare vascular event.
• This finding contrasts with typical GCA presentations involving inflammation rather than dissection.

Implications:

• This case expands the differential diagnosis for patients presenting with suspected GCA and temporal artery abnormalities.
• It underscores the importance of thorough histopathological examination of temporal artery biopsies.
• Further research may be needed to understand the etiology and management of spontaneous isolated STA dissection.