Giant cell arteritis: a case with unusual neurologic manifestations and a normal sedimentation rate

Article Abstract:

Giant cell arteritis (GCA, also called temporal arteritis) is a progressive disorder affecting the blood vessels of the brain. It causes headache, difficulty chewing, weakness rheumatic pains, and sometimes blindness and stroke. It primarily affects women over 70 years old. The diagnostic test for GCA is the erythrocyte sedimentation rate (ESR, the rate at which red blood cells settle); however, there are cases of a normal ESR leading to the wrong diagnosis and a consequent delay in therapy. The case is reported of a 68-year-old woman with partial blindness and progressive pain and weakness. On two visits her physician told her she had osteoarthritis, but anti-inflammatory drugs did not help. Upon admission to the hospital, she had vision problems with her left eye, and ischemic optic neuritis was diagnosed after an ESR was within normal limits. She was given prednisone, which seemed to help, but visual hallucinations began, and she became confused and paralyzed, and prednisone was withdrawn. Tomography (CT), magnetic resonance imaging, and a lumbar puncture were normal. Upon transfer to another hospital, GCA was diagnosed and prednisone therapy restarted. Some of the patient's speech and cognitive abilities returned, but paralysis remained and she requires custodial care. This case was typical of GCA except for the normal ESR and the very severe neurological complications. The misdiagnosis contributed to the patient's neurological deterioration. The use of ESR in patient evaluation has increasingly come under question in the diagnosis of GCA. In spite of this patient's typical symptoms, the normal ESR led to diagnostic delay; patients with less characteristic symptoms could experience even longer delays. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Giant cell arteritis of the breast

Article Abstract:

Giant cell arteritis of the breast is the inflammation of an artery within the breast. It is a rare disease that may resemble breast cancer. Although giant cell arteritis affects the entire body, initial symptoms may involve only the breast. A case is described of a 58-year-old woman with a single painful, red, swollen area on her breast, which was shown to be giant cell arteritis by tissue biopsy. Characteristics of giant cell arteritis include: tender nodules or aggregations of cells on one or both breasts that may resemble breast tumors; symptoms of appetite and weight loss, muscle pain, fever, and joint pain; increased erythrocyte sedimentation rate (the speed at which red blood cells settle); abnormal levels of hemoglobin, the oxygen-carrying pigment of the blood, and of white blood cells; abnormal temporal artery structure; and, rarely, involvement of other organs. Giant cell arteritis may be treated with the steroid prednisone or resolve spontaneously. Many patients with giant cell arteritis of the breast have no abnormalities at other body sites; this form of the disease may resolve spontaneously and require no treatment. The findings of this case were compared to those observed in nine other reported cases of giant cell arteritis of the breast. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Breast diseases

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What you need to know about ... temporal arteritis

Article Abstract:

Temporal arteritis is an inflammation of arteries in scalp and its major symptom is a severe headache. Other symptoms, complications. including blindness and nursing care procedures are described.

Care and treatment, Development and progression

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