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Giant cell arteritis with pulmonary nodules.

J D Bradley, R S Pinals, H B Blumenfeld

    The American Journal of Medicine
    |July 1, 1984
    PubMed
    Summary
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    Polymyalgia rheumatica and temporal arteritis patients may develop pulmonary lesions when steroid doses are reduced. Full steroid doses resolved these symptoms, suggesting a new manifestation of giant cell arteritis.

    Area of Science:

    • Rheumatology
    • Pulmonology
    • Ophthalmology

    Background:

    • Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are common vasculitides in the elderly.
    • Corticosteroids are the mainstay treatment for GCA and PMR.
    • Complications of GCA can affect various organs, including the eyes and lungs.

    Observation:

    • A patient with biopsy-proven temporal arteritis and polymyalgia rheumatica experienced recurrent nodular pulmonary lesions.
    • These pulmonary lesions, along with diplopia and unilateral visual loss, emerged upon reduction of corticosteroid dosage.
    • Symptoms dramatically improved with the reinstitution of full-dose corticosteroid therapy.

    Findings:

    • The pulmonary lesions in this patient are proposed as a novel manifestation of giant cell arteritis.

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  • The findings suggest a potential link between GCA activity and pulmonary involvement.
  • Limited Wegener's granulomatosis involving the temporal artery was considered as an alternative diagnosis.

    • Implications:

    • This case highlights the importance of considering pulmonary involvement in GCA patients, especially during steroid dose tapering.
    • It suggests that pulmonary nodules may represent an under-recognized feature of GCA.
    • Further research is warranted to elucidate the spectrum of GCA manifestations and optimize treatment strategies.