Bilateral Scalp Necrosis in Giant Cell Arteritis
Anisha N Somani1, Bayan Al Othman, Tonse Kini
1McGovern Medical School (ANS), Houston, Texas; Department of Ophthalmology (BAO, TK, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; Department of Ophthalmology (AGL), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Ophthalmology (AGL), Texas A and M College of Medicine, Bryan, Texas; and Department of Ophthalmology (AGL), The University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Giant cell arteritis (GCA) can present with unusual scalp symptoms mimicking herpes zoster. This case highlights GCA
Area of Science:
- Ophthalmology
- Rheumatology
- Dermatology
Background:
- Giant cell arteritis (GCA) is a vasculitis affecting medium-to-large arteries, primarily in older adults.
- Common symptoms include headache, scalp tenderness, and jaw claudication, with visual loss being a feared complication.
- Scalp necrosis is a rare ischemic complication of GCA, with limited reported cases.
Observation:
- A patient presented with scalp pain and a skin lesion resembling herpes zoster ophthalmicus.
- The lesion's distribution corresponded to the ophthalmic division of the trigeminal nerve.
- Initial presentation mimicked a viral infection.
Findings:
- Temporal artery biopsy confirmed Giant cell arteritis (GCA).
- Simultaneous skin biopsy revealed small vessel arteritis.
- This presentation is the first reported case in English ophthalmic literature.
Implications:
- GCA should be considered in the differential diagnosis of scalp lesions, especially in the elderly.
- Early diagnosis and treatment of GCA can prevent severe complications like vision loss.
- This case expands the spectrum of cutaneous manifestations of GCA.
