DOES A NEGATIVE TEMPORAL ARTERY BIOPSY RULE OUT GIANT CELL ARTERITIS WITH LARGE VESSEL INVOLVEMENT?

Document Type

Conference Proceeding

Publication Date

6-23-2023

Publication Title

J Gen Intern Med

Abstract

CASE: A 61-year-old female presented with initial symptoms of abdominal pain, nausea, vomiting, and weight loss. ESR, CRP, and WBC were elevated, and CT imaging revealed abdominal aortitis with retroperitoneal fibrosis and involvement of bilateral iliac arteries. The patient was initiated on high dose corticosteroids and had a negative workup for systematic vasculitis and infectious etiology during her hospital course. She continued an oral steroid regiment once discharged but discontinued her mediation five weeks later. Days after this, the patient presented to the ED with unilateral headache, blurry vision, and left upper limb claudication. Lab values and CT imaging were repeated which showed minimal change from prior admission. Clinical symptoms indicated giant cell arteritis and a temporal artery biopsy was pursued which was negative. The patient received IV corticosteroids, and she reported improvement in her symptoms, including her visual disturbances. She was transitioned to her initial high dose oral corticosteroid regiment and discharged home. IMPACT/DISCUSSION: Small and large vessel vasculitis in giant cell arteritis is more rare than small vessel involvement alone. This case highlights that temporal artery biopsy in a patient with large and small vessel disease has limited sensitivity. Furthermore, prior glucocorticoid treatment modifies the sensitivity of a temporal artery biopsy in addition to other features of the test. This case emphasizes the diagnostic challenge of giant cell arteritis and the limited differential diagnoses for aortitis. Prompt treatment, while indicated, can complicate the investigation, making it difficult to distinguish if the aortic inflammation is part of an idiopathic or systemic process. The diagnosis of giant cell arteritis is critical to appropriate treatment and management with chronic high dose steroids. CONCLUSION: Giant Cell Arteritis with small vessel involvement is generally diagnosed through temporal artery biopsy. However, when the disease involves both small and large vessels and treatment is initiated prior to biopsy, this can influence the diagnostic sensitivity of the biopsy, making the diagnosis challenging.

Volume

38

Issue

Suppl 3

First Page

S456

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