Giant cell arteritis

Case contributed by Dr Enrico Citarella

Presentation

Bilateral temporal pain with visual impairment. Raised serum erythrocyte sedimentation rate (ESR) and serum C reactive protein (CRP). Follow up after steroid therapy.

Patient Data

Age: 75 years
Gender: Female

Baseline ultrasound study

Ultrasound

Hypoechoic and diffused thickening of bilateral temporal arterial walls. The vessels are also tortuous.

Follow up ultrasound study 40 days later after steroid therapy.

Ultrasound

Reduced hypoechoic and thickness of the temporal arterial wall. Vessel's course remains tortuous.
Pulse wave doppler demonstrates normal flow with a well-represented diastolic component.

Case Discussion

After steroid therapy (prednisone 50 mg/die) follow up study shows a substantial reduction of the arterial wall thickening and hypoechogenicity due to phlogosis.

Serum erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) lowered into normal ranges. Symptoms (temporal pain and visual impairment) reduced too.

Unfortunately, a biopsy was not performed, so diagnosis is to be considered presumptive.

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