Giant Cell Arteritis Presenting with Mania, Psychosis, and Cognitive Dysfunction: A Case Report
Heidi Madeleine Latvala1,2, Solveig Klæbo Reitan3,4, Arne Einar Vaaler4,5
1Department of Addiction, Division of Mental Health and Addiction, University Hospital of Northern Norway, Åsgårdvegen 40, 9016 Tromsø, Norway.
Insights
Giant cell arteritis (GCA), an autoimmune vasculitis, can present with unusual psychiatric symptoms like mania. Early diagnosis and treatment are crucial for managing GCA and its diverse manifestations.
Area of Science:
- Rheumatology
- Neurology
- Psychiatry
Background:
- Giant cell arteritis (GCA) is a systemic autoimmune vasculitis targeting medium-to-large arteries.
- Classical GCA symptoms include headache, fever, and jaw claudication, but atypical presentations are increasingly recognized.
- Vascular inflammation in GCA can lead to lumen narrowing, occlusion, vision loss, and stroke.
Observation:
- A 70-year-old woman presented with fluctuating manic symptoms, confusion, headache, and musculoskeletal pain.
- Initial corticosteroid treatment for suspected GCA temporarily worsened manic symptoms.
- Manic symptoms improved after 3-4 weeks of continuous corticosteroid therapy, suggesting a link to GCA.
Findings:
- This case highlights an unprecedented presentation of GCA with prominent psychiatric manifestations.
- The patient's clinical course, including initial manic exacerbation with corticosteroids, is unique.
- GCA was diagnosed based on clinical presentation and response to treatment.
Implications:
- Giant cell arteritis may be underdiagnosed in elderly psychiatric patients.
- Consider GCA in the differential diagnosis of new-onset atypical psychiatric disorders in older adults.
- Raising awareness of GCA's diverse presentations can improve patient outcomes.
Background:
Giant cell arteritis (GCA) is an autoimmune vasculitis affecting medium- and large-sized arteries. Vascular inflammation may lead to narrowing of the arterial lumen, and acute occlusion may result in vision loss and stroke. The classical symptoms include headache, fever, and jaw claudication. However, there is an increasing recognition of atypical presentations. Case Presentation. We report a case of a 70-year-old woman presenting with fluctuating manic symptoms and confusion, in addition to headache and musculoskeletal pain. After diagnosis of GCA, treatment with corticosteroids gradually improved the somatic symptoms.
Conclusion:
Corticosteroids led to a temporary exacerbation of manic symptoms, which improved after 3 to 4 weeks of continuous treatment, indicating that the symptoms were most likely associated with GCA. The patient manifested with clinical features and a clinical course that has, to our knowledge, not been described or published before. Therefore, GCA may be an underdiagnosed disease in psychiatric populations and should be considered in case of atypical, new-onset psychiatric disorders in the elderly.
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