Medial calcific arteriosclerosis mimicking giant cell arteritis
Gill L, Rambhatla P, Kohen L. Medial calcific arteriosclerosis mimicking giant cell arteritis. J Am Acad Dermatol 2015; 75(5):AB149.
J Am Acad Dermatol
Introduction: Medial calcific arteriosclerosis is characterized by diffuse mineral deposition in the tunica media of arterial walls. First described in patients with diabetes mellitus, medial calcific arteriosclerosis has been increasingly recognized in patients with chronic kidney disease. Giant cell arteritis typically presents in people over 50 years old and shows granulomatous inflammatory infiltrate in all layers of the arterial wall. We report a case of medial calcific arteriosclerosis mimicking giant cell arteritis seen in the HFHS Dermatology Clinic. Case report: A 63-year-old African-American female was seen in the HFHS dermatology day hospital for treatment of pruritis from reactive perforating collagenosis secondary to end-stage renal disease. On day six of her treatment, the patient expressed concern of firm, cord-like areas on her bilateral temporal scalp present for one week. She endorsed a 3-month history of chronic headaches, jaw pain and intermittent vision changes. Pulsatile, thickened cord-like vessels were palpated on physical examination. Clinical presentation was suggestive of giant cell arteritis and she was referred for same day consultation with ophthalmology. Her symptoms, elevated erythrocyte sedimentation rate and C-reactive protein were suggestive of giant cell arteritis, and she was immediately started on prednisone. A temporal artery biopsy was performed. Pathology demonstrated Mönckeberg medial calcific arteriosclerosis without any evidence of active or healed arteritis. Despite her negative biopsy, prednisone alleviated her scalp tenderness, jaw claudication, and visual disturbances. She has been continued on 10 mg prednisone daily and is followed by ophthalmology. Discussion: This patient's symptoms and clinical examination closely mimicked findings commonly associated with giant cell arteritis. However, temporal artery biopsy was consistent with medial calcific arteriosclerosis. Mönckeberg medial calcific arteriosclerosis is a calcification process that affects the media of large and medium-sized arteries and is associated with calcification limited to the arterial media. While medial calcific arteriosclerosis is not an entity commonly seen in dermatology, it should be included in the differential diagnosis of end-stage renal disease patients presenting with clinical manifestations of vascular diseases.