A 77-year-old woman with clinical history of systemic hypertension, type 2 diabetes, and hypercholesterolemiawas referred to her general practitioner complaining for subacute onset of symmetrical pain and stiffness in both shoulders and pelvic girdle level. A focused investigation also revealed a vague headache and abrupt onset of visual disturbances, with transient monocular visual loss. She denied jaw claudication, fever, or other constitutional symptoms. Laboratory tests showed an acute-phase response. Her general practitioner prescribed her a course of glucocorticoid therapy (prednisone 25 mg/d), which resulted in complete resolution of musculoskeletal symptoms. At the time of her presentation at our outpatient clinic (after 6 weeks of glucocorticoid therapy), the patient reported that only transient visual disturbances and the slight generalized headache were still present. Moreover, at physical examination, she showed a mild difficulty in raising her arms above shoulder height and in standing up from a chair, but no relevant restriction in both active and passive movements of shoulders and hips. Temporal arteries appeared normal at palpation, without tenderness. Laboratory tests showed a mild microcytic anemia and increased levels of erythrocyte sedimentation rate and C-reactive protein (45 mm/h and 2.10 mg/dL, respectively). Chest x-ray film, echocardiography, and abdominal ultrasound did not show any pathological abnormality. The presence of 3 of 5 American College of Rheumatology classification criteria for giant cell arteritis (GCA) helped us to consider this diagnosis, and despite the glucocorticoid therapy followed in the previous 6 weeks, we decided to obtain a temporal artery specimen. The histological examination confirmed our diagnostic suspicion (Figs. 1 and 2). Patient was treated with prednisone 60 mg/d and subsequent tapering regimen, which resulted in a complete resolution of symptoms and normalization of laboratory tests.
[1]
S. Ramiro,et al.
Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and meta-analysis informing the EULAR recommendations
,
2018,
RMD Open.
[2]
J. Lie.
Illustrated histopathologic classification criteria for selected vasculitis syndromes. American College of Rheumatology Subcommittee on Classification of Vasculitis.
,
2010,
Arthritis and rheumatism.
[3]
D A Bloch,et al.
The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis.
,
2010,
Arthritis and rheumatism.
[4]
K. Barraclough,et al.
BSR and BHPR guidelines for the management of giant cell arteritis.
,
2010,
Rheumatology.
[5]
W M O'Fallon,et al.
How Does Previous Corticosteroid Treatment Affect the Biopsy Findings in Giant Cell (Temporal) Arteritis?
,
1994,
Annals of Internal Medicine.