Treatment-resistant arterial hypertension revealing giant cell arteritis: A case report

Giant cell arteritis (formerly Horton's disease) is an inflammatory large-vessel vasculitis of unknown etiology, primarily affecting individuals over 50 years of age, with a female predominance. Its clinical manifestations are heterogeneous and non-specific, making diagnosis challenging. Histological confirmation by temporal artery biopsy or alternatively 18F-FDG PET/CT when the biopsy isn't possible, remains the diagnostic gold standard.

We report a case highlighting the diagnostic complexity of this condition: a 68-year-old man with no significant medical history, regularly monitored through annual check-ups, who presented with new-onset arterial hypertension associated with persistent headaches. Blood pressure remained uncontrolled despite antihypertensive therapy. The patient subsequently developed significant general deterioration and a prolonged inflammatory syndrome. The diagnosis of Giant cell arteritis was ultimately confirmed through histology, CT angiography, and PET/CT imaging.

Giant cell arteritis does not always present with scalp paresthesia, headache, jaw claudication, or ocular involvement; refractory arterial hypertension associated with a deterioration in general condition should also raise suspicion, as illustrated by our case.