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Pfeil A, Hoffmann T, Freesmeyer M, Oelzner P, Wolf G. [Necrosis of the tongue as a clinical manifestation of giant cell arteritis]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:508-511. [PMID: 37861722 PMCID: PMC11058976 DOI: 10.1007/s00108-023-01607-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
An 83-year-old male patient presented due to a 3-week history of swelling of the tongue with tongue pain on eating, yellowish plaques, and a gray-brown lesion in the anterior portion of the tongue. Sudden loss of vision in the left eye and temporal headache occurred 3 days before presentation. Due to elevated C‑reactive protein, sonography of the supraaortic arteries as well as positron emission tomography/computed tomography was performed. Imaging revealed inflammation of the great arteries as well as a halo sign on ultrasound of the temporal artery. Thus, a diagnosis of giant cell arteritis with necrosis of the tongue was made. Immunosuppressive therapy with glucocorticoids was initiated. Necrosis of the tongue is a rare manifestation of giant cell arteritis that requires immediate immunosuppressive therapy to prevent further complications to the tongue (e.g., complete necrosis of the tongue, superinfection, tongue amputation).
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Affiliation(s)
- Alexander Pfeil
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - Tobias Hoffmann
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Martin Freesmeyer
- Universitätsklinikum Jena, Klinik für Nuklearmedizin, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - Peter Oelzner
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Gunter Wolf
- Universitätsklinikum Jena, Klinik für Innere Medizin III, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland
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Cantón De Seoane J, Gutiérrez Guédez LA, Rodríguez Cambrón AB, Burgos F. Tongue necrosis secondary to giant cell arteritis. BMJ Case Rep 2023; 16:e254888. [PMID: 37192780 PMCID: PMC10193075 DOI: 10.1136/bcr-2023-254888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Tongue necrosis is a rare clinical finding because of its rich vascularisation. Giant cell arteritis (GCA) is the most frequent cause of it, and when present, it is usually one side affected. We describe a patient with several months of constitutional syndrome; during that period, she develops headache followed by tongue necrosis, which lead to clinical suspicion of GCA, later confirmed by a temporal artery biopsy. Before the biopsy, she was treated with corticosteroids. We discuss this illness and tongue necrosis as a rare manifestation to consider.
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Cho YM, El Khoury L, Paramo J, Horowitz DM, Li JY, Kello N. Tongue necrosis secondary to giant cell arteritis, successfully treated with tocilizumab: a case report. BMC Musculoskelet Disord 2023; 24:382. [PMID: 37189114 DOI: 10.1186/s12891-023-06465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Giant Cell Arteritis (GCA) is a large vessel vasculitis that most commonly presents with headache, scalp tenderness, jaw claudication, and vision changes. Various other, less common, manifestations have been reported in the literature such as scalp and tongue necrosis. Though most patients respond to corticosteroids, some cases of GCA are refractory to the high doses of corticosteroids. CASE PRESENTATION We present a 73-year-old female with GCA refractory to corticosteroids presenting with tongue necrosis. This patient significantly improved with a dose of tocilizumab, an IL-6 inhibitor. CONCLUSION To the best of our knowledge, this is the first case report of a patient with refractory GCA presenting with tongue necrosis that had rapid improvement with tocilizumab. Prompt diagnosis and treatment can prevent severe outcomes such as tongue amputation in GCA patients with tongue necrosis, and tocilizumab may be effective for corticosteroid-refractory cases.
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Affiliation(s)
- Young Min Cho
- Department of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA.
| | - Lara El Khoury
- Department of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA
| | - Jonathan Paramo
- Department of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA
| | - Diane Michelle Horowitz
- Department of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA
| | - Jian Yi Li
- Department of Pathology and Laboratory Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA
| | - Nina Kello
- Department of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA
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4
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Yang R, Rhee R. Systemic Manifestations of Giant Cell Arteritis. Int Ophthalmol Clin 2023; 63:1-12. [PMID: 36963823 DOI: 10.1097/iio.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
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5
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Gormley M, Philip J. Acute Ischaemia of the Tongue, a Thromboembolic Event as the First Presentation of Undiagnosed Atrial Fibrillation. J Maxillofac Oral Surg 2022; 21:998-1000. [PMID: 36274891 PMCID: PMC9474980 DOI: 10.1007/s12663-021-01634-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/10/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- M. Gormley
- University of Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY UK
| | - J. Philip
- Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Hull, HU3 2JZ UK
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Lacy A, Nelson R, Koyfman A, Long B. High risk and low prevalence diseases: Giant cell arteritis. Am J Emerg Med 2022; 58:135-140. [DOI: 10.1016/j.ajem.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
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Dhanani U, Zhao MY, Charoenkijkajorn C, Pakravan M, Mortensen PW, Lee AG. Large-Vessel Vasculitis in Ophthalmology: Giant Cell Arteritis and Takayasu Arteritis. Asia Pac J Ophthalmol (Phila) 2022; 11:177-183. [PMID: 35533336 DOI: 10.1097/apo.0000000000000514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
ABSTRACT Giant cell arteritis and Takayasu arteritis are large-vessel vasculitides that share multiple common features but also have significant differences in epidemiology, demographics, clinical presentation, evaluation, and treatment. Giant cell arteritis is more common in elderly patients of Caucasian descent versus Takayasu arteritis, which is more prevalent in younger patients of Asian descent. Although traditionally age has been the main criterion for differentiating the 2 etiologies, modifications in the diagnostic criteria have recognized the overlap between the 2 conditions. In this monograph, we review the diagnostic criteria for both conditions and describe the epidemiology, pathogenesis, histology, evaluation, and management for large-vessel vasculitis in ophthalmology. Additionally, we describe ocular imaging techniques that may be utilized by ophthalmologists to identify manifestations of large-vessel vasculiti- des in patients. Lastly, we compare and contrast the key clinical, laboratory, and pathologic features that might help ophthalmologists to differentiate the 2 entities.
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Affiliation(s)
- Ujalashah Dhanani
- Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, US
| | | | - Chaow Charoenkijkajorn
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
| | - Mohammad Pakravan
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
| | - Peter W Mortensen
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, US
- Departments of Ophthalmology, Neurology, and Neurosurgery, weill Cornell Medicine, New York, NY, US
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, US
- University of Texas MD Anderson Cancer Center, Houston, TX, US
- Texas A and M College of Medicine, Bryan, TX, US
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, US
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8
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Wolcott Z, Goldstein ED. A man with tongue pain: A case study. Headache 2021; 61:1295-1298. [PMID: 34510447 DOI: 10.1111/head.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Zoe Wolcott
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Eric D Goldstein
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
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De León-Benedetti A, Torres LF, Mannava S, Gultekin SH, Margolesky J. Giant Cell Arteritis Presenting With Lingual Artery Infarction. Neurohospitalist 2021; 11:275-276. [PMID: 34163559 DOI: 10.1177/1941874420984863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Luis F Torres
- Department of Neurosurgery, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX, USA
| | - Sishir Mannava
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sakir H Gultekin
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jason Margolesky
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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Ling ML, Yosar J, Lee BW, Shah SA, Jiang IW, Finniss A, Allende A, Francis IC. The diagnosis and management of temporal arteritis. Clin Exp Optom 2021; 103:572-582. [DOI: 10.1111/cxo.12975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/08/2019] [Accepted: 08/07/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Melvin Lh Ling
- Faculty of Medicine, The University of New South Wales, Sydney, Australia,
| | - Jason Yosar
- Faculty of Medicine, The University of Queensland, Brisbane, Australia,
| | - Brendon Wh Lee
- Faculty of Medicine, The University of New South Wales, Sydney, Australia,
| | - Saumil A Shah
- Faculty of Medicine, The University of New South Wales, Sydney, Australia,
| | - Ivy W Jiang
- Faculty of Medicine, The University of New South Wales, Sydney, Australia,
| | | | - Alexandra Allende
- Medical Testing Laboratory, Douglass Hanly Moir Pathology, Sydney, Australia,
| | - Ian C Francis
- Faculty of Medicine, The University of New South Wales, Sydney, Australia,
- Ocular Plastics Unit, Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia,
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11
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A giant deception: jaw pain and headache following routine dental extraction. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e81-e88. [PMID: 32565403 DOI: 10.1016/j.oooo.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/18/2020] [Accepted: 05/13/2020] [Indexed: 11/21/2022]
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12
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DeBord LC, Chiu I, Liou NE. Delayed Diagnosis of Giant Cell Arteritis in the Setting of Isolated Lingual Necrosis. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619857690. [PMID: 31258343 PMCID: PMC6587389 DOI: 10.1177/1179547619857690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 11/15/2022]
Abstract
Background Lingual necrosis is a rare complication of giant cell arteritis (GCA). Methods A 77-year-old woman presented for treatment of a painful and discolored tongue, odynophagia, and dehydration refractory to antimicrobials over 2 weeks. An extensive, well-demarcated necrotic area was visualized on the anterior tongue upon admission. Leukocytosis, thrombocytosis, and elevated erythrocyte sedimentation rate were present. Computed tomography angiogram of the head and neck revealed an undulated-beaded appearance of the distal internal carotid arteries and vertebral arteries bilaterally. Results High-dose intravenous steroids were initiated for suspected vasculitis. Temporal artery biopsy confirmed the diagnosis of GCA. The patient's condition improved and the anterior tongue was well healed at 1 month follow-up. Conclusions An atypical presentation of GCA (eg, isolated lingual necrosis) risks a delay in diagnosis and increased morbidity. Any patient above the age of 50 years presenting with tongue necrosis, in the absence of known cause, should undergo expedited workup for GCA.
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Affiliation(s)
| | - Ilene Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nelson Eddie Liou
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
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13
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Tongue Necrosis Secondary to Giant Cell Arteritis: A Case Report and Literature Review. Case Rep Med 2017; 2017:6327437. [PMID: 28424735 PMCID: PMC5382308 DOI: 10.1155/2017/6327437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/14/2017] [Indexed: 11/17/2022] Open
Abstract
Giant cell arteritis is a form of vasculitis involving the medium- and large-sized arteries that chiefly affects older people. Clinical findings are headache, jaw claudication, fever, pain, and thickening of the temporal artery. The most feared complication is visual loss due to impairment of the ophthalmic artery and posterior ciliary arteries. This a case report of an 85-year-old male presenting with headache and jaw pain, who was admitted with tongue necrosis as an initial manifestation of giant cell arteritis. The necrotic area detached spontaneously after two weeks of therapy with corticosteroids and methotrexate. Reviewing the literature, our patient presented with clinical symptoms consistent with most reports, except for the fact of being male. Although unusual as an initial manifestation, tongue necrosis is an important alert for diagnosing giant cell arteritis. Early diagnosis and treatment of this atypical manifestation may reduce morbidity.
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14
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Chang FY, Natesan S, Goh WY, Anerdis JLD. An Elderly Woman with Tongue Ischemia. J Am Geriatr Soc 2016; 64:e111-e112. [PMID: 27684935 DOI: 10.1111/jgs.14395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Fang Y Chang
- Geriatric Medicine Department, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Wen Y Goh
- Geriatric Medicine Department, Tan Tock Seng Hospital, Singapore, Singapore
| | - Johna L D Anerdis
- Geriatric Medicine Department, Tan Tock Seng Hospital, Singapore, Singapore
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15
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[Chronic or recurrent ulceration of the tongue]. Ann Dermatol Venereol 2016; 143:297-308; quiz 295-6, 309-10. [PMID: 27038855 DOI: 10.1016/j.annder.2016.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/31/2016] [Accepted: 02/04/2016] [Indexed: 11/23/2022]
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16
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Management of giant cell arteritis: Recommendations of the French Study Group for Large Vessel Vasculitis (GEFA). Rev Med Interne 2016; 37:154-65. [DOI: 10.1016/j.revmed.2015.12.015] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 11/17/2022]
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18
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Donaldson SL, Cobine-Davies M, Morgan AW, Gough A, Mackie SL. Curry-assisted diagnosis in the rheumatology clinic. Oxf Med Case Reports 2015; 2015:297-9. [PMID: 26069840 PMCID: PMC4455788 DOI: 10.1093/omcr/omv040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/30/2015] [Accepted: 04/18/2015] [Indexed: 11/14/2022] Open
Abstract
We report five cases of glucocorticoid-responsive mouth symptoms in polymyalgia rheumatica/giant cell arteritis (GCA); three cases of tongue pain exacerbated by hot/spicy food, a case of scalp pain made worse by eating hot/spicy food and a case of sore tongue as a presenting feature of GCA. These cases emphasize the importance of asking about mouth symptoms and changes in taste when evaluating patients with suspected GCA.
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Affiliation(s)
| | | | - Ann W Morgan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine , University of Leeds , Leeds , UK
| | - Andrew Gough
- Rheumatology Department , Harrogate and District Foundation NHS Trust , Harrogate , UK
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine , University of Leeds , Leeds , UK
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Abstract
Necrosis of the tongue is a rare clinical finding. The rich vascularity of the tongue means necrosis is uncommon but it has been reported secondary to giant cell arthritis, radiotherapy and ischaemia. We report the case of a 61-year-old man admitted with an acute abdomen, who later developed gross swelling of the tongue, secondary to ischaemic necrosis, which necessitated tracheostomy placement. The ischaemia was managed conservatively with heparinisation and by allowing the ischaemic area to demarcate and slough off naturally.
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Affiliation(s)
| | - Irfan Khan
- Department of Maxillofacial, Cork University Hospital, Cork, Ireland
| | - Chris J Cotter
- Department of Maxillofacial, Cork University Hospital, Cork, Ireland
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20
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Abstract
The noninfectious, inflammatory vasculitides include giant cell arteritis, Takayasu disease, Churg-Strauss angiitis, Wegener disease, polyarteritis nodosa, microscopic polyangiitis, Buerger disease, amyloid-β-related angiitis, and isolated vasculitis of the central nervous system. While these disorders are relatively uncommon, they produce a variety of neurologic diseases including muscle disease, mononeuropathy multiplex, polyneuropathy, cranial nerve palsies, visual loss, seizures, an encephalopathy, venous thrombosis, ischemic stroke, and intracranial hemorrhage. The multisystem vasculitides often have stereotypical clinical findings that reflect disease of the kidney, sinuses, lungs, skin, joints, or cardiovascular system. These disorders also usually have abnormalities found on serologic testing. Isolated vasculitis of the central nervous system is more difficult to diagnose because the clinical and brain imaging findings are relatively nonspecific. Examination of the cerebrospinal fluid will demonstrate changes consistent with an inflammatory process. Arteriography often shows areas of segmental narrowing affecting multiple intracranial vessels and brain/meningeal biopsy may be required to establish the diagnosis. Management of patients with a multisystem vasculitis or isolated vasculitis of the central nervous system is centered on the administration of immunosuppressive agents. In many cases, corticosteroids remain the mainstay of medical treatment.
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Affiliation(s)
- Harold P Adams
- Division of Cerebrovascular Diseases, Department of Neurology, Carver College of Medicine, University of Iowa Health Care Stroke Center, University of Iowa, Iowa City, IA, USA.
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Kumar R, Gupta H, Jadhav A, Khadilkar S. Bitemporal scalp, lip and tongue necrosis in giant cell arteritis: a rare presentation. Indian J Dermatol 2013; 58:328. [PMID: 23919029 PMCID: PMC3726906 DOI: 10.4103/0019-5154.113980] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 74-year-old man was presented with fever, bilateral throbbing temporoparietal headache, jaw claudication, and bilateral loss of vision. On examination, he had bilateral scalp necrosis with impending necrosis of lip and tongue. Temporal artery biopsy was done, and it was compatible with active temporal arteritis. This is one of the rare presentations of giant cell arteritis where there is simultaneous necrosis of scalp, lip, and tongue, and to the best of our knowledge, it is the first case reported from India.
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Affiliation(s)
- Rajesh Kumar
- Department of Dermatology, Bombay Hospital and Medical Research Center, Mumbai, India
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22
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Unusual large tongue ulcer. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:4-8. [PMID: 23768874 DOI: 10.1016/j.oooo.2012.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 12/18/2011] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
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Kumarasinghe AP, Hepburn A, Reuther WJ, Pratt C. Temporal arteritis presenting with tongue necrosis. BMJ Case Rep 2012; 2012:bcr-2012-007241. [PMID: 23166175 DOI: 10.1136/bcr-2012-007241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spontaneous glossodynia is uncommon and glossodynia progressing to necrosis is especially rare. Although the commonest cause of lingual necrosis is giant cell arteritis, only a few cases of a new diagnosis of giant cell arteritis, clinically presenting with isolated lingual necrosis, have been reported.
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Schmidt J, Warrington KJ. Polymyalgia rheumatica and giant cell arteritis in older patients: diagnosis and pharmacological management. Drugs Aging 2012; 28:651-66. [PMID: 21812500 DOI: 10.2165/11592500-000000000-00000] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Giant cell arteritis (GCA) is an inflammatory vasculopathy that involves large- and medium-sized arteries and can cause vision loss, stroke and aneurysms. GCA occurs in people aged >50 years and is more common in women. A higher incidence of the disease is observed in populations from Northern European countries. Polymyalgia rheumatica (PMR) is a periarticular inflammatory process manifesting as pain and stiffness in the neck, shoulders and pelvic girdle. PMR shares the same pattern of age and sex distribution as GCA. The pathophysiology of PMR and GCA is not completely understood, but the two conditions may be related and often occur concurrently. A delay in the diagnosis should be avoided because of the risk of vascular ischaemic complications due to GCA. The diagnosis should be considered in patients aged >50 years presenting with symptoms such as new headache, visual disturbances, jaw claudication or symptoms of PMR. GCA can also present as a systemic inflammatory syndrome with fever of unknown origin. Marked elevation of acute-phase reactants, recognizable in higher erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, is often seen in both PMR and GCA. However, some patients can present with a normal ESR. Confirmation of the diagnosis of GCA by temporal artery biopsy is important because clinical findings and laboratory tests are not specific, and because a diagnosis of GCA commits patients to long-term treatment with corticosteroids. The role of imaging techniques for the diagnosis of GCA remains unclear, but these modalities can be helpful in assessing the extent of vascular involvement, especially when extra-cranial disease is present. In PMR, subdeltoid and subacromial bursitis can be identified by imaging techniques, especially ultrasound or MRI. The clinical manifestations of GCA and PMR respond dramatically within 12-48 hours of starting corticosteroid treatment. The initial corticosteroid dosage commonly used in GCA is oral prednisone 40-60 mg/day, and for patients with PMR a dosage of 15-20 mg/day is often sufficient. A prolonged course of treatment is necessary, and corticosteroids are gradually tapered, guided by regular clinical evaluation and ESR (and/or CRP) measurement. Methotrexate is the best studied corticosteroid-sparing agent in GCA, and may be useful for patients with frequent disease relapses and/or corticosteroid-related toxicity. Retrospective studies favour aspirin (acetylsalicylic acid) as an effective adjuvant treatment for reducing the ischaemic complications of GCA. The long-term course of corticosteroid therapy frequently exposes elderly patients with PMR/GCA to various adverse effects, which can be attenuated with appropriate prophylactic measures. Co-morbid diseases and polypharmacy can pose particular challenges in the geriatric population. In general, the life expectancy of patients with GCA does not appear to be shortened, whereas the morbidity associated with the disease and its treatment is well recognized.
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Affiliation(s)
- Jean Schmidt
- Department of Internal Medicine and RECIF, Amiens University Hospital, France
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25
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Jennings S, Singh S. Necrotic tongue: a rare manifestation of giant cell arteritis. J Rheumatol 2011; 38:2688. [PMID: 22134796 DOI: 10.3899/jrheum.110780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Scott Jennings
- Moruya District Hospital, Moruya, New South Wales, Australia.
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Lin JR, Wang H, Collins AB, Stone JR. Tongue necrosis and systemic vascular amyloidosis. Hum Pathol 2011; 42:734-7. [PMID: 21236468 DOI: 10.1016/j.humpath.2010.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Revised: 08/19/2010] [Accepted: 08/25/2010] [Indexed: 11/16/2022]
Abstract
Tongue necrosis is a rare but dramatic clinical finding, which is most often related to infection, trauma, malignancy, or vasculitis. We describe an extremely unusual case in which systemic amyloid deposition in small arteries caused by senile systemic amyloidosis was associated with necrosis of the tongue as well as necrosis of portions of the bowel. To our knowledge, this is the first report of ischemic tongue necrosis resulting from vascular amyloidosis.
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Affiliation(s)
- James R Lin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Roman BR, Immerman SB, Morris LGT. Ischemic necrosis of the tongue in patients with cardiogenic shock. Laryngoscope 2010; 120:1345-9. [PMID: 20564667 DOI: 10.1002/lary.20974] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Ischemic necrosis of the tongue is a rare entity generally associated with vasculitis. Critically ill patients with shock might experience hypoperfusion of head and neck end organs including the tongue. STUDY DESIGN Retrospective analysis of hospital charts. METHODS Case histories and photographs of five patients who developed ischemic tongue necrosis in the context of cardiogenic shock. RESULTS Five critically ill patients in our institution's cardiothoracic intensive care unit developed ischemic necrosis of the tongue. All five patients experienced protracted courses of profound cardiogenic shock requiring high-dose vasopressor support and urgent cardiac surgery. Three patients required intra-aortic balloon pumps. All patients had concomitant signs of poor end organ perfusion, including lower extremity ischemia and renal and hepatic failure. Ultimately, four of five patients died, with one patient surviving after sloughing of the entire oral tongue. CONCLUSIONS Ischemic necrosis of the oral tongue is an uncommon but perhaps under-reported manifestation of end organ hypoperfusion in shock, likely signifying poor prognosis.
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Affiliation(s)
- Benjamin R Roman
- Department of Otolaryngology, New York University Medical Center, New York, New York 10016, USA
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Azghari A, Lekehal B, El Mesnaoui A, Bensaid Y. Arteritis de células gigantes evidenciada por ulceraciones de la mano. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)15006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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