Development of intracranial vasculitis in giant cell arteritis during tocilizumab treatment

Giant cell arteritis (GCA), a systemic large-vessel vasculitis, is a disease that has been treated with glucocorticoids since 1950. Over the years, several disease-modifying anti-rheumatic drugs have been evaluated as steroid-sparing agents with disappointing results. Tocilizumab, an interleukin-6 inhibitor, has in recent years been approved for the treatment of GCA. It remains uncertain whether the drug suppresses disease activity and maintains remission or just alleviates the symptoms and masks the signs of smoldering disease. This case describes the clinical findings at diagnosis and the course of the disease with the subsequent development of intracranial vasculitis in a 70-year-old male treated with tocilizumab. The present case illustrates the need for further studies regarding tocilizumab in the treatment of GCA patients and the need for meticulous evaluation at follow-ups.