Lingual necrosis in giant-cell arteritis: a case-based review.

Area of Science:

• Rheumatology
• Vascular Medicine
• Internal Medicine

Background:

• Lingual necrosis is a rare but serious complication of giant cell arteritis (GCA).
• Diagnosis can be challenging, especially with atypical presentations lacking classic GCA symptoms.
• This case highlights a younger patient with risk factors like smoking and migraines.

Purpose of the Study:

• To present a case of lingual necrosis secondary to GCA in a patient with an atypical presentation.
• To review existing literature on lingual necrosis in GCA.
• To evaluate the role of tocilizumab in managing GCA-associated lingual necrosis.

Main Methods:

• Case report of a 59-year-old female with severe tongue pain and neck discomfort.
• Initiation of glucocorticoid therapy followed by tocilizumab due to symptom exacerbation upon steroid dose reduction.
• Literature review of 55 reported cases of lingual necrosis in GCA.

Main Results:

• The patient showed marked reduction in tongue swelling and progressive healing after tocilizumab initiation.
• Review revealed an average patient age of 77.8 years, female predominance, and hypertension as a common risk factor.
• 32.7% of reviewed cases presented with lingual necrosis as the initial GCA manifestation; 13 patients required additional immunosuppressants beyond glucocorticoids.

Conclusions:

• GCA should be considered in the differential diagnosis of lingual necrosis, even in younger patients or those with atypical symptoms.
• Early detection and prompt treatment are essential to prevent irreversible damage.
• Tocilizumab shows promise as an effective therapeutic option for GCA-associated lingual necrosis refractory to glucocorticoids.