[Steroid-sensitive cavitating pulmonary opacity in Horton's disease]

Area of Science:

• Rheumatology
• Pulmonology

Background:

• Giant cell arteritis, also known as Horton's disease, is a systemic vasculitis that can affect large and medium-sized arteries.
• Pulmonary involvement in Horton's disease is rare but can manifest as various lung pathologies.

Observation:

• A 72-year-old woman with a history of Horton's disease presented with cavitating pneumonia and general deterioration.
• The patient's condition worsened during a steroid dose reduction, prompting suspicion of pulmonary involvement.

Findings:

• Initial treatment with anti-tuberculous therapy was ineffective, and the patient's condition deteriorated.
• Increasing steroid dosage led to rapid regression of pulmonary lesions, supporting a diagnosis of pulmonary Horton's disease.
• Bacteriological and Lowenstein medium cultures were negative for tuberculosis.

Implications:

• This case highlights the importance of considering pulmonary manifestations of Horton's disease in patients with unexplained lung lesions and constitutional symptoms.
• Diagnosis of pulmonary Horton's disease can be challenging and often relies on clinical response to immunosuppressive therapy and exclusion of other causes.
• While anti-tuberculous treatment may be continued empirically, prompt recognition and appropriate management with corticosteroids are crucial.