Scalp necrosis in giant cell arteritis: Case report and review of the relevance of this cutaneous sign of large-vessel vasculitis
Department of Dermatology, University of Muenster, Muenster, Germany.Journal of the American Academy of Dermatology (Impact Factor: 4.45). 08/2009; 61(4):701-6. DOI: 10.1016/j.jaad.2008.11.913
Giant cell arteritis (GCA) is a systemic vasculitis associated with severe complications such as loss of vision and, rarely, scalp necrosis. We present a patient with GCA who had bilateral scalp necrosis and an erythrocyte sedimentation rate of only 21 mm after the first hour. Therapy with systemic steroids, which were slowly tapered over 1 year, led to secondary wound healing without recurrence. As there are no systematic reviews on the occurrence of scalp necrosis in patients with GCA, we performed a literature research and meta-analysis and discovered 78 cases published between 1946 and 2007. Analysis of the data revealed that GCA with scalp necrosis is associated with a higher incidence of vision loss (32%) and other visual defects (37.3%) than GCA without scalp necrosis (visual disturbances in up to 20%). GCA with scalp necrosis is also associated with an increased mortality (standard mortality ratio [SMR], 4.2) in contrast to GCA without scalp necrosis, which has no significantly higher mortality than age-matched controls (SMR 0.8-1.034). In patients with scalp necrosis, the diagnosis of GCA was made about 1 month later than in patients without scalp necrosis, and scalp necrosis was never reported to occur after onset of therapy with glucocorticoids. Thus, for reasons beyond potential loss of vision, physicians should be alert for symptoms of GCA as only timely diagnosis and immediate therapy may prevent serious complications and increased mortality.
Article: Bitemporale Skalpnekrose[Show abstract] [Hide abstract]
ABSTRACT: Wir berichten über eine 71-jährige Patientin, die innerhalb von 4 Wochen stark schmerzhafte und größenprogrediente bitemporale Nekrosen der Kopfhaut entwickelte. Begleitet wurde dieser Befund von Kopfschmerzen sowie Myalgien und einer Muskelschwäche vor allem im Bereich des Schultergürtels. Der klinische Verdacht einer Riesenzellarteriitis der A. temporalis mit Skalpnekrosen konnte mittels Arterienbiopsie histologisch bestätigt werden. Unter der systemischen Glukokortikoidtherapie, die insgesamt über 18 Monate ausschleichend durchgeführt wurde, war die Patientin schnell beschwerdefrei, und die Nekrosen heilten nach erfolgreicher Konditionierung des Wundgrundes und Spalthauttransplantation ab. Der Fall stellt eine sehr seltene, schwerwiegende und häufig mit einer schlechten Prognose vergesellschaftete Komplikation der Riesenzellarteriitis der A. temporalis dar.
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ABSTRACT: Introduction. Giant cell arteritis is a chronic vasculitis of large and medium-sized arteries that usually affects elderly patients in the majority of cases. Involvement of the cranial arteries leads to the classic symptoms of headache, painful thickening of the temporal artery, jaw claudication, and visual loss. It could be complicated of necrosis of scalp and tongue bul exceptionally it induce necrosis of hand. Case report. A 74-year-old woman admilted for ulcer of the left arm. Physical exam revealed the absence of pulse of upper limbs. The Dúplex ultrasonography of cervical arteritis showed a homogeneous thickening wilh inflammalory features. The biopsy specimens were taken from the temporal artery. Histologic examination revealed a dense infíltrate of the media wilh lymphocyíes and giant cells, which confirmed the diagnosis of Horton disease. The patient was treated by corticosleroids and anticoagulation drugs immediately after diagnosis was proven and their symptoms improved wilh healing of lesions; the follow-up was uneventful with improvement of symptoms and disappearance of the ulcer that healed after four months. [ANGIOLOGÍA 2009; 61: 271-4]
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