Case Example Temporal Arteritis with Tongue Necrosis

last modified on: Wed, 02/28/2018 - 12:30

Back to: Temporal Arteritis aka Giant Cell Arteritis and Temporal Artery Biopsy Technique

see: Steroids Side Effects Systemic Corticosteroid Therapy Adverse Effects

CLINICAL HISTORY: S.W. is a 66-year-old Caucasian female who presented with 4 episodes of transient R sided vision loss, a 5-day history of worsening tip of tongue burning, and a 1 month history of non-pulsatile headache mostly of occipital distribution with scalp tenderness at 'veins' noted while combing her hair. She was found to have elevated LFTs, ESR and CRP. She had a total thyroidectomy 2 weeks prior to presentation for papillary thyroid carcinoma with neck dissection revealing disease metastatic to lymph nodes.

Initial Presentation                          10 Days after initial presentation

S.W. was started on Solumedrol 1000mg qd for a presumptive diagnosis of temporal arteritis. On hospital day 3, she underwent a R temporal artery biopsy:

*Biopsy Photo is NOT intended for instructional purposes, only for completeness in case report. For instruction, see 'Temporal Artery Biopsy' in Temporal Arteritis aka Giant Cell Arteritis and Temporal Artery Biopsy Technique


MICROSCOPIC DESCRIPTION: The intima is relatively unremarkable. The muscularis layers and adventitial layers are infiltrated with lymphocytes and epithelioid histiocytes. Many of these are adjacent to the internal elastic lamina. The lamina demonstrates mild disruption on elastic stain.

DIAGNOSIS: Granulomatous arteritis consistent with giant cell arteritis.

TREATMENT: Solumedrol 1000mg qd x 3days, then Prednisone taper 80mg qd x 1wk, 70mg qd x 2wks, 60mg qd x 2wks

see: Steroids Side Effects Systemic Corticosteroid Therapy Adverse Effects

 

Pathology Slides: Courtesy of Nasreen A. Syed MD, Depts. of Ophthalmology and Pathology, University of Iowa