Giant Cell Arteritis and the Use of Ultrasound in Its Diagnosis

Giant cell arteritis is a form of vasculitis causing inflammation of large and medium-sized arteries, including the aorta and its major branches and the temporal artery. Temporal artery biopsy can confirm the diagnosis and should be performed as soon as possible after referral but should not interfere with the initiation of glucocorticoid therapy. A biopsy is typically performed within one week of starting glucocorticoids. However, false negatives may occur due to the segmental nature of giant cell arteritis, inadequate vessel length, or inadequate interpretation. A 60-year-old male with a past medical history of type II diabetes mellitus presented with a headache for the past three days. He did not report any worsening of vision. Physical examination was significant for prominent bilateral temporal arteries and bilateral shoulder, arm, and hip tenderness. Carotid artery duplex ultrasound showed less than 50% stenoses of the internal carotid arteries bilaterally. The patient reported improvement of symptoms, including headache and shoulder and hip pain following steroids. The patient was also continued on prednisone 20 mg and started on tocilizumab 162 mg once weekly. This case report highlights the significance of a duplex ultrasound of carotid arteries as an effective alternative to temporal artery biopsy. Duplex ultrasound is a more sensitive, non-invasive, and cost-effective test and could be considered as an aid in diagnosis.