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Giant Cell Arteritis Presenting as Cholestatic Hepatitis.

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Giant cell arteritis (GCA) rarely causes severe liver problems. This case shows GCA can present with high alkaline phosphatase (ALP) levels, emphasizing the need for broader diagnostic considerations.

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Area of Science:

  • Rheumatology
  • Hepatology
  • Internal Medicine

Background:

  • Giant cell arteritis (GCA) typically affects medium-to-large arteries.
  • Atypical presentations of GCA can delay diagnosis and increase risks, such as visual loss.
  • Severely deranged liver function tests (LFTs) are an uncommon manifestation of GCA.

Observation:

  • A patient presented with significant cholestatic liver enzyme abnormalities, including a peak alkaline phosphatase (ALP) of 3091 IU/L.
  • The patient also experienced symptoms of sinus pain, fevers, and a dry cough.
  • These LFT derangements are the highest recorded in a GCA patient.

Findings:

  • Bilateral temporal artery biopsies confirmed the diagnosis of giant cell arteritis (GCA).
  • The patient's symptoms and abnormal LFTs, including ALP, showed improvement with corticosteroid treatment.

Implications:

  • This case underscores the importance of considering GCA in the differential diagnosis of unexplained cholestatic liver abnormalities.
  • Early diagnosis and treatment of GCA are crucial to prevent severe complications like vision loss.
  • Highlights the diverse clinical spectrum of giant cell arteritis.