Giant cell arteritis without cranial manifestations caused mesenteric involvement: a case report

Area of Science:

• Vascular Inflammation
• Gastrointestinal Pathology
• Rheumatology

Background:

• Giant cell arteritis (GCA) is a large vessel vasculitis primarily affecting the aorta and cranial arteries.
• While typically presenting with cranial symptoms, GCA can manifest extracranially, sometimes without cranial involvement.

Purpose of the Study:

• To report a rare case of GCA involving the jejunum and mesentery without cranial symptoms.
• To describe the histopathological findings of extracranial GCA in vascular and gastrointestinal tissues.

Main Methods:

• A 76-year-old female presented with acute abdominal pain and fever, lacking cranial symptoms.
• Diagnostic laparotomy revealed thickened mesentery and ascites; jejunal resection was performed.
• Histopathological examination of resected tissue showed characteristic GCA features, including giant cells and vascular intimal hypertrophy.

Main Results:

• The patient presented with acute abdomen and fever, diagnosed as GCA of the mesentery.
• Histopathology revealed marked vascular intimal hypertrophy, inflammatory cell infiltration, and giant cells in the jejunum and mesentery.
• The patient recovered well post-surgery and was managed with prednisolone.

Conclusions:

• This case highlights mesenteric GCA as a rare but significant extracranial manifestation.
• Histopathological findings underscore the characteristic vascular changes of GCA in affected arteries, veins, and jejunum.
• Early recognition and appropriate treatment are crucial for managing extracranial GCA.