Temporal lobe meningioma masked by polymyalgia rheumatica

Area of Science:

• Neurology
• Rheumatology
• Oncology

Background:

• Polymyalgia rheumatica (PMR) is an inflammatory condition common in the elderly, often presenting with muscle pain and stiffness.
• Giant cell arteritis (GCA) is a vasculitis that can co-occur with PMR, causing symptoms like severe headache.
• Temporal artery biopsy is a standard diagnostic tool for GCA, but can yield false negatives.

Observation:

• An elderly female patient presented with classic polymyalgia rheumatica symptoms and severe headache.
• Despite negative temporal artery biopsies, giant cell arteritis was suspected and corticosteroid treatment was initiated.
• Autopsy revealed a large temporal lobe meningioma as the cause of the headache, with no evidence of arteritis.

Findings:

• The case highlights a diagnostic challenge where symptoms of polymyalgia rheumatica and severe headache mimicked giant cell arteritis.
• A temporal lobe meningioma, a brain tumor, was the unexpected cause of the patient's severe headache.
• Histological examination of temporal arteries did not confirm giant cell arteritis.

Implications:

• Patients presenting with polymyalgia rheumatica and headache require comprehensive evaluation to rule out occult conditions like meningioma.
• Overlapping symptoms between polymyalgia rheumatica and neurological conditions necessitate careful differential diagnosis, especially with inconclusive biopsy results.
• This case underscores the importance of considering non-vascular pathologies in elderly patients with polymyalgia rheumatica and persistent headaches.