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Arbaoui S, Rezziki A, Kejiou H, Serraj KA, Benzirar A, El Mahi O. [Bilateral sub-acute upper limb ischemia revealing Horton's disease, a rare presentation : A case report and literature review]. Ann Cardiol Angeiol (Paris) 2024; 73:101677. [PMID: 37984239 DOI: 10.1016/j.ancard.2023.101677] [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] [Received: 05/27/2023] [Revised: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 11/22/2023]
Abstract
STUDY'S GOAL Our goal is to enrich the medical literature by sharing our experience in managing a case of sub-acute upper limb ischemia that revealed Horton's disease. This is particularly relevant given the current lack of well-established guidelines. INTRODUCTION Acute upper limb ischemia is rarely seen in Horton's disease. CASE REPORT We present a case of a 63-year-old female patient with sub-acute ischemia in both upper limbs, accompanied by jaw claudication and absence of bilateral temporal pulses. The CT Angiography scan revealed bilateral occlusions and stenosis of the axillary and sub-clavier arteries, as well as involvement of the external carotid arteries and its branches. The Arteriography confirmed abnormalities in the medium-sized arteries of the supra-aortic trunks. The histopathology examination of the temporal artery biopsy was negative. The patient received emergency corticosteroid therapy followed by an immunosuppressant. Due to the improved clinical condition of the upper limbs, surgical intervention was not performed.
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Affiliation(s)
- S Arbaoui
- Département de Chirurgie Vasculaire, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc.
| | - A Rezziki
- Département de Chirurgie Vasculaire, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc.
| | - H Kejiou
- Département de Chirurgie Vasculaire, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc.
| | - K A Serraj
- Département de médecine interne, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - A Benzirar
- Département de Chirurgie Vasculaire, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc.
| | - O El Mahi
- Département de Chirurgie Vasculaire, Université Mohammed Premier, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc.
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Abstract
Glucocorticoids (GC) remain the gold standard of the treatment of giant cell arteritis provided objectives of GC-tapering are accurately followed: 15 to 20mg/day at 3 months, 10mg/day at 6 months, 5mg/day at 9-12 months and withdrawal between 12 and 18 months. In case of corticodependance at ≥7.5 mg/day of prednisone or intolerance to GC, a GCsparing therapy has to be introduced, mainly methotrexate or tocilizumab. Individual characteristics of each patient, data about the efficacy of the treatment, its cost and how easy the follow-up under this treatment is are important factors to consider for choosing the right GC-sparing therapy. For all these reasons, except particular situations, we prefer using methotrexate before tocilizumab. Prevention of cardiovascular events is an important aspect of the treatment of GCA. We recommend using aspirin (75-100mg/day) during the first month of treatment or longer in case of occurrence of an ischemic complication. Each patient treated for GCA should receive a prevention of osteoporosis with respect of usual recommendations.
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Kern L, Kermen S, Hamdan S, Loubière H, Hery L, De Ybarlucea L, Closs-Prophette F. Artérite à cellules géantes révélée par une atteinte des membres inférieurs. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.211] [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]
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Almeida-Morais L, Galego S, Marques N, Pack T, Rodrigues H, Abreu R, Vasconcelos L, Marques H, Sousa Guerreiro A. Acute upper limb ischemia, a rare presentation of giant cell arteritis. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Almeida-Morais L, Galego S, Marques N, Pack T, Rodrigues H, Abreu R, Vasconcelos L, Marques H, Sousa Guerreiro A. Acute upper limb ischemia, a rare presentation of giant cell arteritis. Rev Port Cardiol 2016; 35:237.e1-4. [PMID: 27006059 DOI: 10.1016/j.repc.2015.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/13/2015] [Indexed: 11/29/2022] Open
Abstract
Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10-15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis. We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure. The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers. GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization.
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Affiliation(s)
- Luís Almeida-Morais
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal.
| | - Sofia Galego
- Unidade Funcional Medicina IV, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal
| | - Nélia Marques
- Unidade Funcional Medicina IV, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal
| | - Tiago Pack
- Unidade Funcional Medicina IV, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal
| | - Hugo Rodrigues
- Serviço de Cirurgia Vascular, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal
| | - Rodolfo Abreu
- Serviço de Cirurgia Vascular, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal
| | - Leonor Vasconcelos
- Serviço de Cirurgia Vascular, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal
| | - Hugo Marques
- Serviço de Radiologia, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal
| | - António Sousa Guerreiro
- Unidade Funcional Medicina IV, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal
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Goupil de Bouillé J, Lecouffe-Desprets M, Bigot A, Halimi JM, Courtehoux M, Guilmot JL, Breteau C, Diot E. Phénomène de Raynaud unilatéral isolé révélateur d’une artérite à cellules géantes multifocale (maladie de Horton) compliquée d’ischémie rénale. ACTA ACUST UNITED AC 2015; 40:200-5. [DOI: 10.1016/j.jmv.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/09/2015] [Indexed: 10/23/2022]
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Apigian AK, Landry GJ. Basic data underlying decision making in nonatherosclerotic causes of intermittent claudication. Ann Vasc Surg 2014; 29:138-53. [PMID: 25277047 DOI: 10.1016/j.avsg.2014.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 01/13/2023]
Abstract
Although most cases of vasculogenic intermittent claudication are caused by atherosclerosis, there is an important minority of cases that are due to nonatherosclerotic causes. Because of their rarity and younger population affected, often without traditional atherosclerotic risk factors, there is frequently a significant delay in diagnosis of nonatherosclerotic peripheral arterial diseases by several months to years in some cases. Here, we review the literature on nonatherosclerotic causes of lower extremity claudication, symptoms, management including surgical and endovascular interventions, and outcomes. Conditions included are popliteal artery entrapment syndrome, cystic adventitial disease, pseudoxanthoma elasticum, persistent sciatic artery, fibromuscular disease, giant cell arteritis, iliac endofibrosis, neurogenic claudication, and chronic exertional compartment syndrome.
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Affiliation(s)
- Aimie K Apigian
- Knight Cardiovascular Institute, Oregon Health & Science University, Sam Jackson Park Road, Portland, OR
| | - Gregory J Landry
- Knight Cardiovascular Institute, Oregon Health & Science University, Sam Jackson Park Road, Portland, OR.
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Daumas A, Rossi P, Bernard-Guervilly F, Francès Y, Berbis J, Durand JM, Kaplanski G, Ebbo M, Harlé JR, Weiller PJ, Serratrice J, Disdier P, Gayet S, Villani P, Granel B. Caractéristiques cliniques, paracliniques et profil évolutif de l’atteinte aortique de la maladie de Horton : à propos de 26 cas d’aortite parmi 63 cas de maladie de Horton. Rev Med Interne 2014; 35:4-15. [DOI: 10.1016/j.revmed.2013.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 03/15/2013] [Accepted: 06/15/2013] [Indexed: 11/24/2022]
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Thromboses inhabituelles et syndrome catastrophique des antiphospholipides. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-013-0716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Marie I. Maladie de Horton et pseudopolyarthrite rhizomélique : critères diagnostiques. Rev Med Interne 2013; 34:403-11. [DOI: 10.1016/j.revmed.2013.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 10/27/2022]
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Abstract
Thromboangiitis obliterans, or Buerger disease, is a chronic nonatherosclerotic endarteritis manifesting as inflammation and thrombosis of distal extremity small and medium-sized arteries resulting in relapsing episodes of distal extremity ischemia. Takayasu arteritis is a rare syndrome characterized by inflammation of the aortic arch, pulmonary, coronary, and cerebral vessels, presenting with cerebrovascular symptoms, myocardial ischemia, or upper extremity claudication in young, often female, patients. Kawasaki disease is a small- and medium-vessel acute systemic vasculitis of young children, with morbidity and mortality stemming from coronary artery aneurysms. Microscopic polyangiitis, Churg-Strauss syndrome, and Wegener granulomatosis are systemic small-vessel vasculitides, affecting arterioles, capillary beds and venules, and each presenting with variable effects on the pulmonary, renal and gastrointestinal systems.
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Affiliation(s)
- William Wu
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Pedinielli A, Keller-Petrot I, Fardet L. [A case of giant cell arteritis [correction of arthritis] diagnosed with 18FDG-positron emission tomography]. Presse Med 2012; 41:1304-6. [PMID: 22361028 DOI: 10.1016/j.lpm.2012.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 12/15/2011] [Accepted: 01/04/2012] [Indexed: 11/24/2022] Open
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