Giant cell arteritis (Horton's disease) of the axillary artery--case reports

The authors recently observed 2 elderly female patients with ischemic pain of the upper extremity as the first manifestation of giant cell arteritis. They presented with rest pain of both upper extremities and even gangrene of the thumb in 1 case. Subclavian and radial pulses were absent while peripheral pulses in the lower limbs were preserved. The angiography was so typical that the diagnosis of inflammatory arteritis was made, despite negative temporal artery biopsy. The patient with thumb gangrene was successfully operated on, the occlusive axillary lesions being bypassed by a long venous carotid humeral bypass graft. A biopsy of the axillary artery showed a granulomatous lymphoplasmocellular infiltration. A high-dose corticotherapy (24 mg daily) was begun in both cases, with dramatic improvements of general state, lowering of the erythrocyte sedimentation rate, and even reapparition of a reduced radial pulse in 1 patient. The authors discuss the incidence, symptoms, diagnosis, and treatment of systemic giant cell arteritis, with special attention to extracranial involvement. These case reports may broaden the knowledge of the diverse manifestations of giant cell arteritis and of its systemic character with widespread vascular involvement.