[Hutchinson-Horton ulcero-necrotizing cranial arteritis]

Arteritis cranialis ulcero-necroticans Hutchinson-Horton is the necrotizing variant of giant-cell temporal arteritis, which was first described by Hutchinson in 1890 and Horton in 1932. Although the histomorphological findings (occluding proliferation of the intima, destruction of the elastica interna, giant-cell infiltration) suggest reactive pathomechanisms, the aetiology of the disease remains rather uncertain. The hypothesis currently favoured is that auto-immunological processes originate from vascular alterations and subsequently lead to the recognition of antigenic determinants by the host immune system being followed by immunological response mechanisms clinically manifest as vasculitis. Arteritis cranialis is most frequently found in the temporal artery; however, the reasons for this preferential location are not clearly established, and giant-cell arteritis can also be found elsewhere. Ulceration of the skin can be encountered and may affect large areas of the scalp, depending on the vascular perfusion pattern involved. The case report described in this paper comprises anamnestic data, clinical and serological findings, and the histological picture typical for giant-cell arteritis. Stress is laid on the importance of early diagnosis to prevent irreversible complications with possibly fatal outcome.