1
|
Brar AS, Nanda R, Narayanan R, Padhy SK. Giant Cell Arteritis With Bilateral Central Retinal Artery Occlusion and Tongue Necrosis. Cureus 2024; 16:e59554. [PMID: 38826883 PMCID: PMC11144274 DOI: 10.7759/cureus.59554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
This case report describes a complicated case of giant cell arteritis (GCA) with tongue necrosis and bilateral central retinal artery occlusion (CRAO). An 81-year-old male patient with a history of recent retinal artery occlusion, ischemic stroke, and hypertensive emergency was evaluated. Clinical examination, including a visual acuity assessment, fundus evaluation, and oral examination, was performed. Laboratory investigations, such as erythrocyte sedimentation rate (ESR), were conducted. A temporal artery biopsy was performed to confirm the diagnosis of GCA. The patient presented with sudden vision loss in the left eye following a prior episode of retinal artery occlusion in the right eye. Ophthalmoscopic examination revealed CRAO in the left eye. Additionally, tongue necrosis, a rare manifestation of GCA, was observed. The ESR was significantly elevated. A temporal artery biopsy supported the diagnosis of GCA. The patient was promptly referred for immunologist consultation and initiated on intravenous methylprednisolone therapy. This case highlights the diverse and potentially devastating nature of GCA, involving ocular and systemic manifestations. Bilateral CRAO and tongue necrosis are rare but significant complications of GCA. Prompt diagnosis and early initiation of corticosteroid therapy are crucial to prevent irreversible visual loss and further complications. A multidisciplinary approach involving ophthalmologists and other specialists is essential for the comprehensive management of GCA.
Collapse
Affiliation(s)
- Anand S Brar
- Ophthalmology, LV Prasad Eye Institute, Mithu Tulsi Chanrai (MTC) Campus, Bhubaneswar, IND
| | - Ridham Nanda
- Ophthalmology, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu, IND
- Ophthalmology, LV Prasad Eye Institute, Mithu Tulsi Chanrai (MTC) Campus, Bhubaneswar, IND
| | - Raja Narayanan
- Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, IND
| | - Srikanta K Padhy
- Ophthalmology, LV Prasad Eye Institute, Mithu Tulsi Chanrai (MTC) Campus, Bhubaneswar, IND
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Rose EC, Carroll LS, Evans S, Mason A. Giant cell arteritis complicated by tongue necrosis and bilateral cerebellar ischaemic stroke. BMJ Case Rep 2021; 14:e244948. [PMID: 34880035 PMCID: PMC8655573 DOI: 10.1136/bcr-2021-244948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
Giant cell arteritis (GCA) typically presents with headache, scalp tenderness or visual disturbance. Other symptoms include orofacial pain, constitutional symptoms and ischaemic stroke. An 81-year-old woman with a background of type-2 diabetes and hypertension presented with headache, oral pain and right visual loss. Examination showed hypertension, nodular temporal arteries, reduced visual acuity and suspected oral candida. Inflammatory markers were raised and she was diagnosed with GCA and commenced on corticosteroids. During treatment she developed tongue ulceration, then acute vertigo and incoordination with nystagmus and ataxia. Neuroimaging confirmed bilateral, cerebellar ischaemic strokes and temporal artery biopsy was consistent with GCA. With corticosteroids and secondary prevention of stroke measures she is now functionally independent. Oral pain is an uncommon symptom of GCA and delays in recognition may lead to catastrophic consequences. Clinicians should be aware of uncommon presentations and to optimise additional ischaemic stroke risk-factors.
Collapse
Affiliation(s)
- Emily Charlotte Rose
- Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Liam Stuart Carroll
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sue Evans
- Department of Stroke Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alice Mason
- Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
4
|
Dos Reis LA, Faustino ISP, Vargas PA, Dos Santos-Silva AR, Lopes MA. Lingual necrosis leading to the diagnosis of giant cell arteritis. SPECIAL CARE IN DENTISTRY 2021; 41:408-410. [PMID: 33512010 DOI: 10.1111/scd.12571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 11/29/2022]
Abstract
Giant cell arteritis (GCA) is a chronic vasculitis comprising large- and medium-sized arteries branches originating from the aortic arch. GCA diagnosis might be challenging due to its several clinical characteristics. This clinical report describes a case of a 91-year-old woman who was admitted with tongue necrosis. Medical history revealed mild headache episodes and jaw numbness. Summing up clinical and laboratory findings, the diagnosis of GCA was established. Surgical debridement and corticotherapy led to complete resolution of the tongue lesion with no need for any additional intervention. In this case report, we highlight the importance of GCA early diagnosis in order to avoid more serious complications.
Collapse
Affiliation(s)
- Leonardo Amaral Dos Reis
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil.,Basic Sciences Department, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | | | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil
| | - Alan Roger Dos Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas-UNICAMP, Campinas, Sao Paulo, Brazil
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Wang SJ, Olson NJ, Kieffer KA. A Picture's Worth: Giant Cell Arteritis. Am J Med 2016; 129:942-4. [PMID: 27215906 DOI: 10.1016/j.amjmed.2016.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Sijie Jason Wang
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Nicholas J Olson
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kelly A Kieffer
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| |
Collapse
|
7
|
Tongue necrosis as an initial manifestation of giant cell arteritis: case report and review of the literature. Case Rep Rheumatol 2015; 2015:901795. [PMID: 25802790 PMCID: PMC4329787 DOI: 10.1155/2015/901795] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/07/2015] [Indexed: 01/10/2023] Open
Abstract
Giant cell arteritis (GCA) is a systemic vasculitis of medium and large arteries that mainly affects the external carotid artery. It is a diagnosis of the elderly that typically presents as low-grade fever, temporal tenderness, claudication of the jaw, and in some patients vision loss. In cases where GCA presents with atypical manifestations, the diagnosis may be more difficult, causing a delay in both diagnosis and treatment and ultimately leading to irreversible complications. In this paper, we present an atypical presentation of GCA with symptoms of neck swelling and lingual pain in an elderly female. These symptoms progressed to bilateral necrosis and eventual dislodgement of the tongue. Lingual necrosis is a severe potential complication in GCA. In patients presenting with lingual swelling, pain, and discoloration, GCA should be suspected and prompt therapy should be initiated to avoid irreversible complications.
Collapse
|
8
|
Grant SWJ, Underhill HC, Atkin P. Giant cell arteritis affecting the tongue: a case report and review of the literature. ACTA ACUST UNITED AC 2014; 40:669-70, 673-4, 677. [PMID: 24279219 DOI: 10.12968/denu.2013.40.8.669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Giant cell arteritis (GCA) is a systemic vasculitis with symptoms that could cause a patient to present to a general dental practitioner. A case of GCA that presented as headache, jaw claudication, unilateral visual loss and tongue ulceration leading to necrosis is reported and the literature reviewed, with an emphasis on dentally relevant aspects. It is vital that GCA is not overlooked in patients over the age of 50 with unexplained dental pain, tissue necrosis or jaw pain which may be misdiagnosed as a temporomandibular joint disorder. Early diagnosis and prompt treatment is the key to preventing visual loss. Early referral in such cases would be warranted. CLINICAL RELEVANCE Dental clinicians may play a part in the early diagnosis of GCA by having a high index of suspicion for its symptoms in patients, so that devastating ischaemic consequences, such as irreversible visual loss, can be prevented.
Collapse
Affiliation(s)
- Simon W J Grant
- Department of Oral Medicine, University Dental Hospital, Heath Park, Cardiff CF14 4XW, UK
| | | | | |
Collapse
|
9
|
[Skin necrosis in a patient with temporal arteritis]. ACTA ACUST UNITED AC 2011; 7:198-9. [PMID: 21794812 DOI: 10.1016/j.reuma.2010.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 06/21/2010] [Accepted: 06/24/2010] [Indexed: 11/22/2022]
Abstract
We present the case of a 91 years old patient diagnosed through biopsy with temporal arteritis who, in addition, had scalp necrosis. We briefly review the literature for published cases.
Collapse
|
10
|
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.
Collapse
Affiliation(s)
- Benjamin R Roman
- Department of Otolaryngology, New York University Medical Center, New York, New York 10016, USA
| | | | | |
Collapse
|
11
|
Tongue infarction as first symptom of temporal arteritis. Rheumatol Int 2010; 32:799-800. [PMID: 20058010 DOI: 10.1007/s00296-009-1355-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 12/29/2009] [Indexed: 10/20/2022]
Abstract
Giant cell arteritis (GCA) is the most common systemic vasculitis affecting people over 50 years. This disease is a diagnostic challenge with a range of clinical symptoms and findings due to different affected vessels. Because of this, the initial diagnosis can be tricky, and some of the patients present at first time with a real unusual initial manifestation. One of these can be tongue necrosis, which is according to the literature in accordance with scalp necrosis, the rarest initial manifestation of GCA We describe a patient who presented with tongue necrosis as initial symptom of GCA. The belated diagnose resulted in subtotal necrosis of the mobile part of the tongue.
Collapse
|
12
|
Córdoba S, Martínez D, Martín L, Borbujo J. Úlcera lingual como manifestación de la arteritis temporal. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s0001-7310(09)70543-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
13
|
Tongue necrosis as first symptom of giant cell arteritis (GCA). Clin Rheumatol 2009; 28 Suppl 1:S47-9. [PMID: 19277817 DOI: 10.1007/s10067-009-1141-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 02/11/2009] [Indexed: 10/21/2022]
Abstract
Giant cell arteritis (GCA) is the most common systemic vasculitis affecting people over the age of 50 years, especially in the western world. Nevertheless, the initial diagnosis can be tricky, as some of the patients present at first time with a real unusual initial manifestation. One of these can be tongue necrosis, which is according to the literature in accordance with scalp necrosis, the rarest initial manifestation form of GCA. We describe two patients who presented with tongue necrosis as initial symptom of GCA. The diagnosis was made by the American College of Rheumatology criteria, biopsy and duplex sonography of their temporal arteries. A typical halo was seen as a sign of intimal edema. The patients were put on corticosteroids immediately after diagnosis was proven and their symptoms improved quickly.
Collapse
|
14
|
Córdoba S, Martínez D, Martín L, Borbujo J. Tongue Ulcer as a Manifestation of Temporal Arteritis. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
15
|
Carter LM, Brizman E. Lingual infarction in Wegener's Granulomatosis: a case report and review of the literature. Head Face Med 2008; 4:19. [PMID: 18718013 PMCID: PMC2531096 DOI: 10.1186/1746-160x-4-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 08/21/2008] [Indexed: 11/12/2022] Open
Abstract
Wegener's granulomatosis (WG) is a multi-system disease, characterised by the triad of necrotising granulomata affecting the upper and lower respiratory tracts, disseminated vasculitis and glomerulonephritis. Oral lesions are associated with up to 50% of cases, although are rare as a presenting feature. The most common oral lesions associated with WG are ulceration and strawberry gingivitis. We review the literature regarding oral manifestations of WG and present a case of lingual infarction, an extremely rare oral lesion associated with WG, in a severe, rapidly progressive and ultimately fatal form of the disease.
Collapse
Affiliation(s)
- Lachlan M Carter
- Maxillofacial Surgery, Leeds Dental Institute, Clarendon Way, Leeds, UK.
| | | |
Collapse
|
16
|
Sainuddin S, Saeed NR. Acute bilateral tongue necrosis--a case report. Br J Oral Maxillofac Surg 2008; 46:671-2. [PMID: 18499311 DOI: 10.1016/j.bjoms.2008.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2008] [Indexed: 11/18/2022]
Abstract
We report the case of an 88-year-old lady who presented with acute necrosis of the whole tongue. Giant cell arteritis was suspected, and early treatment with corticosteroids led to complete resolution and no need for further intervention. We emphasise the importance of early diagnosis of giant cell arteritis and treatment with corticosteroids to stabilise the condition and to avoid serious ocular complications.
Collapse
Affiliation(s)
- Sajid Sainuddin
- Department of Oral & Maxillofacial Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom. sajid
| | | |
Collapse
|
17
|
Ciantar M, Adlam DM. Glossodynia and necrosis of the tongue caused by giant cell arteritis. Br J Oral Maxillofac Surg 2008; 46:231-233. [PMID: 17482729 DOI: 10.1016/j.bjoms.2007.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
Spontaneous, endogenous pain in the tongue (glossodynia) is rare, particularly when this progresses to ulceration and necrosis of the tongue. We report the case of a 74-year-old woman who presented with glossodynia that eventually resulted in necrosis of the tongue. The diminished blood supply was the result of histologically confirmed giant cell arteritis.
Collapse
Affiliation(s)
- Marilou Ciantar
- Department of Oral & Maxillofacial Surgery, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, Cambridgeshire, United Kingdom.
| | - David M Adlam
- Department of Oral & Maxillofacial Surgery, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, Cambridgeshire, United Kingdom.
| |
Collapse
|
18
|
Schurr C, Berthele A, Burghartz M, Kiefer J. Spontaneous bilateral necrosis of the tongue: a manifestation of giant cell arteritis? Eur Arch Otorhinolaryngol 2008; 265:993-8. [PMID: 18214514 DOI: 10.1007/s00405-007-0556-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Accepted: 11/26/2007] [Indexed: 11/26/2022]
Abstract
Giant cell arteritis is a chronic vasculitis, which involves large- and medium-sized branches of the arteries originating from the aortic arch. This disease is a diagnostic challenge with a wide range of clinical symptoms and findings due to different affected vessels. Classic symptoms are temporally located headache, thickened temporal artery and jaw claudication. Furthermore, visual symptoms like diplopia or loss of vision can occur. The tongue has an excellent blood supply and ischemic ulceration due to giant cell vasculitis is usually unilateral and rarely described in literature. We present a patient with a spontaneous bilateral tongue necrosis and are convinced that this extraordinary case must be deemed to be a manifestation of giant cell arteritis, although it does not completly satisfy the usually used diagnostic criteria formulated by the American College of Rheumatology.
Collapse
Affiliation(s)
- Christian Schurr
- Otolaryngology, Head and Neck Surgery, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | | | | | | |
Collapse
|
19
|
[Tongue necrosis under corticosteroids]. ACTA ACUST UNITED AC 2008; 109:48-50. [PMID: 18207476 DOI: 10.1016/j.stomax.2007.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 09/10/2007] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The tongue is a common location for Horton necrotic injuries. But some herpetic lesions can show similar symptoms to the disease and complicate the diagnosis. CASE REPORT A 67-year-old woman, treated by corticosteroids for Horton disease, presented a central, deep, and very painful ulceration of the tongue. The spreading of necrosis despite treatment was an indication for biopsy, giving the diagnosis of herpetic infection. Valacyclovir was efficient within 15 days. DISCUSSION This necrotic injury looks like herpetic stomatitis presented by severely immunodeficient AIDS patients. No case under corticosteroids had been described so far. The tongue-limited location is exceptional.
Collapse
|
20
|
Goicochea M, Correale J, Bonamico L, Dominguez R, Bagg E, Famulari A, Ameriso S, Sevlever G. Tongue necrosis in temporal arteritis. Headache 2008; 47:1213-5. [PMID: 17883530 DOI: 10.1111/j.1526-4610.2007.00890.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Temporal arteritis is a form of systemic vasculitis that involves branches of the carotid artery. Clinical features are headache, visual loss, ophthalmoplegia, jaw claudication, temporal headache, with tenderness and thickening on the affected temporal artery. We present 3 cases of tongue necrosis due to this granulomatous arteritis. Ischemic necrosis of the tongue is unusual and appears to be an association between its occurrence and high dose steroid tapering.
Collapse
|
21
|
Paraskevas KI, Boumpas DT, Vrentzos GE, Mikhailidis DP. Oral and ocular/orbital manifestations of temporal arteritis: a disease with deceptive clinical symptoms and devastating consequences. Clin Rheumatol 2006; 26:1044-8. [PMID: 17180298 DOI: 10.1007/s10067-006-0493-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
Temporal arteritis (TA) is a chronic, systemic vasculitis most often presenting with severe headaches localized in the temporal region, low-grade fever, anorexia, weight loss and generalized malaise. Besides these typical characteristics, a number of vague and non-specific oral and/or ocular symptoms may also be present. A search using Medline (1955-2006) was performed for unusual oral and ocular/orbital presentations of TA. A variety of oral and ocular/orbital manifestations associated with TA have been reported. These can mislead physicians, causing a delay in establishing a diagnosis and initiating treatment. Increased awareness is necessary for the prompt recognition of this potentially devastating disease. Particularly, dentists and ophthalmologists should include TA in their differential diagnosis, as they may be the first to deal with these patients.
Collapse
Affiliation(s)
- Kosmas I Paraskevas
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic), Royal Free Hospital, Pond Street, London NW3 2QG, UK.
| | | | | | | |
Collapse
|
22
|
Zachariades N, Skoura C, Spanou A, Machera H. Temporal arteritis: report of a case. ACTA ACUST UNITED AC 2006; 102:192-7. [PMID: 16876061 DOI: 10.1016/j.tripleo.2005.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Revised: 05/03/2005] [Accepted: 06/13/2005] [Indexed: 11/18/2022]
Abstract
Temporal arteritis is a rheumatic disease that affects large and medium-sized arteries. It is a severe arteritis involving both the intima and media of the vessel and is a cause of headache that is frequently diagnosed erroneously as "atypical migraine." The patients have a burning or throbbing type of pain. Ultimately, there is localized inflammation or cellulitis over the swollen, tortuous artery. Jaw claudication, eye pain, photophobia, diplopia, and even blindness may accompany the temporal symptoms. As many as 20% to 60% of inadequately treated or untreated patients will lose their vision. Blindness may or may not be preceded by visual symptoms and funduscopic changes. A variety of systemic symptoms are also often present, including nausea, vomiting, chills, dizziness, and loss of weight. Temporal arteritis is not a common diagnosis in maxillofacial practice. We are presenting a case of temporal arteritis diagnosed after a biopsy. The patient eventually lost the vision from one eye.
Collapse
Affiliation(s)
- Nicholas Zachariades
- Oral and Maxillofacial Department, KAT General District Hospital, Kifissia, Athens, Greece.
| | | | | | | |
Collapse
|