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Disseminated giant cell arteritis
1Department of Pathology, Mount Sinai School of Medicine, City Hospital Center at Elmhurst, New York, New York.
Insights
Giant cell arteritis and polymyalgia rheumatica can affect various blood vessels. This case highlights unusual widespread arterial involvement, including coronary arteries, leading to a fatal myocardial infarction.
Area of Science:
- Rheumatology
- Pathology
- Cardiovascular Medicine
Background:
- Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are common vasculitides in the elderly.
- GCA typically affects cranial arteries, while PMR involves proximal muscles.
Observation:
- A 76-year-old woman presented with features of both GCA and PMR.
- Autopsy revealed extensive arteritis involving cranial, large elastic, and small muscular arteries, including vasa vasorum.
Findings:
- Histological examination confirmed simultaneous involvement of temporal arteries (biopsy) and widespread systemic arteries (autopsy).
- Coronary arteritis was identified as the cause of fatal myocardial infarction.
Implications:
- This case underscores the potential for extensive and simultaneous arterial system involvement in GCA/PMR.
- It emphasizes the critical need for early diagnosis and comprehensive management to prevent severe cardiovascular complications like myocardial infarction.
Abstract:
A 76-yr-old woman with widespread giant cell arteritis and polymyalgia rheumatica is described. The patient had an unusual simultaneous involvement of the cranial (temporal) arteries demonstrated by biopsy, and of large elastic arteries (aorta and its major branches), medium-sized and small muscular arteries, arterioles and vasa vasorum found at autopsy. Coronary arteritis was responsible for the fatal myocardial infarction.