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Alkatan HM, AlMana F, Maktabi AMY. Giant cell temporal arteritis: a clinicopathological study with emphasis on unnecessary biopsy. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1327420. [PMID: 38983072 PMCID: PMC11182246 DOI: 10.3389/fopht.2023.1327420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/23/2023] [Indexed: 07/11/2024]
Abstract
Introduction Temporal artery (TA) biopsy is commonly used for the diagnosis of giant cell arteritis (GCA). However, a positive biopsy is no longer mandatory for diagnosis. This study aims to correlate the histopathological findings of TA biopsies in suspected cases of GCA to the clinical presentation in an ophthalmic tertiary eye care center to draw useful conclusions and advocate the possible implementation of guidelines for TA biopsy. Methods Data was collected from patients' medical records including, demographics, clinical data, and histopathological findings and diagnosis. The 2022 American College of Rheumatology/ European Alliance of Associations for Rheumatology (ACR/EULAR) criteria have been used and partially adopted as a guide to compare the variables between TA biopsy-positive and negative groups as well as the TA biopsy-positive group and the group of patients with TA biopsy showing atherosclerosis. Results Out of the total 35 patients who underwent a TA biopsy during the period of 23 years, 22.9% of patients had histopathological findings consistent with GCA and 42.9% had TA atherosclerotic changes, while the remaining 34.3% had histologically unremarkable TA. The mean age of all patients was 66 ± 10.9 years. Slightly more than half were females (54.3%) and the remaining were males (45.7%). In the group with positive TA biopsies, the mean age was 71 ± 8.4 years with a higher female predominance (female-to-male ratio of 5:3). The mean diagnostic clinical score used in our study was higher (7.5 ± 2.33) in the GCA-positive group when compared to the other groups with statistical significance (mean of 4.85 ± 2.01 in patients with overall GCA-negative biopsies and 5.13 ± 2.10 in the group with atherosclerosis). Other three clinical variables that were found to be statistically significant in the GCA biopsy-positive group were scalp tenderness, jaw claudication, and optic nerve pallor. Discussion The mean age (71 ± 8.4 years) and the female predominance of GCA in our group of patients with positive TA biopsy (62.5%) was like other reports. In our study 22.9% of performed TA biopsies over the period of the study were positive confirming the diagnosis of GCA on histological exam, which was similar to another report and is considered to be relatively low. The incorporation of increased clinically focused assessments and algorithms, with the aid of the ACR/EULAR criteria, may decrease the frequency of TA biopsies that carries unnecessary cost and risk of procedure-related morbidity. We highly recommend applying the age of ≥ 50 years as an initial criterion for diagnosis, followed by the consideration of the statistically significant clinical features: scalp tenderness, jaw claudication, and optic nerve pallor.
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Affiliation(s)
- Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fawziah AlMana
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Pandya BU, Jhaveri A, Shamshad F, Margolin EA, Micieli JA. The Causes of Optic Disc Edema in Patients Presenting With Significantly Compromised Vision. J Neuroophthalmol 2023:00041327-990000000-00499. [PMID: 37938075 DOI: 10.1097/wno.0000000000002030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND To evaluate the most common causes of optic disc edema (ODE) in patients with significantly compromised vision (initial best-corrected visual acuity [BCVA] of 20/400 or worse) at presentation. METHODS Retrospective chart review over a 5-year period of consecutive patients presenting to tertiary neuro-ophthalmology clinics at the University of Toronto. RESULTS A total of 656 patients with ODE were included, and 49 patients (7.47%) had an initial BCVA of 20/400 or worse. There were 54 eyes included at baseline and 49 eyes at final follow-up. There were 29 female and 20 male patients. The mean age at first visit across patients was 55.9 years. Female patients (n = 29) were significantly older than male patients (n = 20) (P < 0.05). The causes of ODE were optic neuritis (ON) (n = 22; 40.7%), nonarteritic anterior ischemic optic neuropathy (NAION) (n = 22; 40.7%), arteritic anterior ischemic optic neuropathy (AAION) (n = 5; 9.26%), uveitis-related (n = 3; 5.56%), papilledema from idiopathic intracranial hypertension (IIH) (n = 1; 1.85%), and Vogt-Koyanagi-Harada disease (n = 1; 1.85%). Initial BCVA was not significantly different between ON and NAION groups (P = 0.52); however, final BCVA was significantly better in the ON group (P < 0.0001). The mean initial BCVA was worst in the AAION group (2.62 ± 0.54 logarithm of the minimum angle of resolution). The most common cause of ODE in patients <40 years old was ON (83.3%), whereas the 2 most common causes in patients >80 were NAION (60%) and AAION (40%). In patients between the ages of 60-80, NAION (100%) was the only cause. CONCLUSIONS Patients with ODE and poor vision at presentation represent a minority of cases seen in neuro-ophthalmology clinics (<10%). Optic neuritis and NAION are the 2 most common causes of ODE with poor vision at presentation. These findings are limited by a small sample size and potential sampling bias.
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Affiliation(s)
- Bhadra U Pandya
- Temerty Faculty of Medicine (BUP, AJ), University of Toronto, Toronto, Canada; Faculty of Medicine (FS), University of Alberta, Edmonton, Canada; Department of Ophthalmology and Vision Sciences (EAM, JAM), Faculty of Medicine, University of Toronto, Toronto, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Canada
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Miano DI, Cosgrove R, Sherman J, Balaraman S, Sherman M. Pembrolizumab-Induced Giant Cell Arteritis in the Setting of Urothelial Carcinoma. Neuroophthalmology 2022; 47:93-99. [PMID: 36891407 PMCID: PMC9988338 DOI: 10.1080/01658107.2022.2108847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 10/14/2022] Open
Abstract
A 65-year-old male presented to the Ophthalmology clinic with painless loss of vision in his right eye. Over the previous week the right eye's vision had progressed from being blurry to complete loss. Three weeks prior to presentation he had begun treatment with pembrolizumab for urothelial carcinoma. Ophthalmological assessment and subsequent imaging prompted further investigation, and a temporal artery biopsy confirmed a diagnosis of giant cell arteritis. This case demonstrates a rare, yet serious, condition of biopsy-confirmed giant cell arteritis in the setting of pembrolizumab treatment for urothelial carcinoma. In addition to reporting a vision threatening side effect of pembrolizumab we emphasise the need for vigilant care of patients on this drug as symptomatology and laboratory results may be inconspicuous.
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Affiliation(s)
- Deanna Ingrassia Miano
- Department of Ophthalmology, Ascension Eye Institute - Ascension Macomb-Oakland Hospital, Warren, Michigan, USA
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, USA
| | - Ryan Cosgrove
- Department of Ophthalmology, Ascension Eye Institute - Ascension Macomb-Oakland Hospital, Warren, Michigan, USA
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, USA
| | - Joshua Sherman
- Lyman Briggs College, Michigan State University, East Lansing, Michigan, USA
| | | | - Michael Sherman
- Department of Ophthalmology, Ascension Eye Institute - Ascension Macomb-Oakland Hospital, Warren, Michigan, USA
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, USA
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Babazadeh A, Barary M, Ebrahimpour S, Sio TT, Mohseni Afshar Z. Non-arteritic anterior ischemic optic neuropathy as an atypical feature of COVID-19: A case report. J Fr Ophtalmol 2022; 45:e171-e173. [PMID: 35031149 PMCID: PMC8733217 DOI: 10.1016/j.jfo.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Barary
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Das S, Khurana T, Tiwary R. Various etiologies and presentations of giant cell arteritis: A series of case reports. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_116_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chaudhary H, Zachariah S, Schwartz J. Central Retinal Artery Occlusion Secondary to Giant Cell Arteritis With Normal Inflammatory Markers. J Clin Rheumatol 2021; 27:S335-S337. [PMID: 33657589 DOI: 10.1097/rhu.0000000000001682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dimancea A, Guidoux C, Amarenco P. Minor Ischemic Stroke and a Smoldering Case of Giant-Cell Arteritis: A Case Report. Stroke 2021; 52:e749-e752. [PMID: 34619985 DOI: 10.1161/strokeaha.121.035432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Celine Guidoux
- Neurology Department, Bichat Claude-Bernard Hospital, Paris
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Mandura RA. Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy. Cureus 2021; 13:e16653. [PMID: 34462685 PMCID: PMC8387793 DOI: 10.7759/cureus.16653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/05/2022] Open
Abstract
Giant cell arteritis (GCA) is a rare inflammatory vasculitis of unknown cause that involves large and medium arteries. Arteritic anterior ischemic optic neuropathy (AAION) is attributed to vascular occlusion of the posterior ciliary arteries (PCAs) which supply the optic nerve head (ONH). AAION is the most common ophthalmic complication of GCA and can cause sudden and irreversible loss of vision with a high risk of involvement of the second eye. A 57-year-old female patient presented with unilateral sudden onset visual loss in the right eye (OD) for two days. It was accompanied by severe right-sided headache and scalp tenderness on the right temple, neck as well as the presence of jaw pain over the past three months. Visual acuity (VA) was hand motion (HM) OD, and 20/20 in the left eye (OS). Fundus examination revealed diffuse swollen optic disc with pallid "chalky white" appearance OD and normal healthy optic disc OS. A dramatically elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found. Therefore, a diagnosis of GCA was made, and immediate IV methylprednisolone was started followed by oral prednisone doses. A right temporal artery (TA) biopsy was done later and was negative. On follow-up, VA has maintained at HM level OD, and no involvement of the second eye occurred. GCA is a rare form of vasculitis that can be difficult to diagnose especially in the setting of negative TA biopsy. We support the evidence that negative TA biopsy does not rule out clinically suspected GCA with elevated ESR and CRP and recommend keeping a low index of suspicion as immediate treatment is required to prevent irreversible vision loss.
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Temporal Artery Biopsy in the Workup of Giant Cell Arteritis: Diagnostic Considerations in a Veterans Administration Cohort. J Neuroophthalmol 2020; 40:450-456. [PMID: 32868573 DOI: 10.1097/wno.0000000000001040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Giant cell arteritis (GCA) is the most common systemic vasculitis in the American population older than 50 years and is a sight-threatening and life-threatening disease. It is definitively diagnosed with a temporal artery biopsy. Although there are many studies focusing on the clinical presentation and laboratory values in diagnosing GCA in the general population, studies focusing on the veteran population are lacking. This is the first study describing the diagnostic features of GCA in the US military veterans. METHODS We performed a retrospective chart review in the Veterans Information Systems and Technology Architecture Computerized Patient Record System (CPRS 1.0, Department of Veterans Affairs Health Data Systems). Anatomic pathology reports from temporal artery biopsies (TABs) were collected, as well as the clinical presentation and laboratory values for each case. Frequency, sensitivity, and specificity were calculated for clinical variables, such as new-onset headache and vision changes, including diplopia, ischemic vision loss/optic disc disease, and amaurosis fugax. A logistic regression (LR) prediction model was then developed to compare veteran risk factors with those of the general population. RESULTS Of 292 patients, 40 had positive TABs (13.7%). The average age of subjects with positive TABs was 73 ± 8.8 years (mean ± SD). The average erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in patients with positive TABs (69.1 mm/hr and 56.6 mg/L, respectively) were significantly higher than ESR and CRP in patients with negative TABs (50.5 mm/hr, P = 0.0016 and 32.2 mg/L, P = 0.0394, respectively). Mean platelet levels were much higher (317.6 × 10/L) in patients with positive TABs than platelet levels in those with negative TABs (260.6 × 10/L, P = 0.0005). CRP was the most sensitive variable at 83.3%, followed by ESR with a sensitivity of 80% and new-onset headache with a sensitivity of 62.5%. Jaw claudication and polymyalgia rheumatica (PMR) were most specific (81.3% and 89.3%, respectively). Headache was the most common presenting symptom overall (71.6%), followed by vision changes (50.3%), scalp tenderness (25.7%), jaw claudication (20.9%), and PMR-related symptoms (12.7%). The LR prediction model included scalp tenderness, log (CRP), log (platelets), vision changes, and age, with 50% sensitivity and 88.36% specificity. Platelets (odds ratio [OR] = 4.309, P = 0.049), CRP (OR = 1.504, P = 0.022) and scalp tenderness (OR = 3.860, P = 0.016) were statistically significant predictors of a positive TAB in this population. CONCLUSIONS Veterans Administration (VA) patients present with symptomatology similar to that of the general population. A positive biopsy was found in female veterans more frequently than in their male counterparts. Platelet count and scalp tenderness were most predictive. Our LR model provided a highly specific method for detecting GCA in the veteran population at this institution, but further studies are needed to determine the generalizability of the model. This retrospective study serves as a basis for future multicenter VA-wide studies to characterize the unique features in this population.
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Temporal arteritis, Sjögren's syndrome and mixed pain components as manifestations in a diabetic older adult: systematic review based on a case report. Reumatologia 2020; 58:179-183. [PMID: 32684652 PMCID: PMC7362268 DOI: 10.5114/reum.2020.96684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
Temporal arteritis (TA) is an inflammatory vascular disease common in the European population. It is mainly characterized by sudden onset headache. TA is rarely associated with other autoimmune diseases, such as Sjögren's syndrome (SS). We present the case of a Peruvian 71 year-old man with SS history, who was admitted to the emergency department due to severe headache evolved in 4 days, periocular pain and right ptosis. The authors also performed a systematic review of case reports or case series of patients diagnosed with both TA and SS. This temporal arteritis case is an atypical presentation because headache was characterized by mixed nociceptive and neuropathic pain components. Despite the infrequency, new studies should be carried out to identify comorbidities in TA patients.
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Ralli M, Campo F, Angeletti D, Minni A, Artico M, Greco A, Polimeni A, de Vincentiis M. Pathophysiology and therapy of systemic vasculitides. EXCLI JOURNAL 2020; 19:817-854. [PMID: 32665772 PMCID: PMC7355154 DOI: 10.17179/excli2020-1512] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
Systemic vasculitides represent uncommon conditions characterized by the inflammation of blood vessels that can lead to different complex disorders limited to one organ or potentially involving multiple organs and systems. Systemic vasculitides are classified according to the diameter of the vessel that they mainly affect (small, medium, large, or variable). The pathogenetic mechanisms of systemic vasculitides are still partly unknown, as well as their genetic basis. For most of the primary systemic vasculitides, a single gold standard test is not available, and diagnosis is often made after having ruled out other mimicking conditions. Current research has focused on new management protocol and therapeutic strategies aimed at improving long-term patient outcomes and avoiding progression to multiorgan failure with irreversible damage. In this narrative review, authors describe different forms of systemic vasculitides through a review of the literature, with the aim of highlighting the current knowledge and recent findings on etiopathogenesis, diagnosis and therapy.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Italy
| | | | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Marco Artico
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
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Shah SM, Khanna CL. Ophthalmic Emergencies for the Clinician. Mayo Clin Proc 2020; 95:1050-1058. [PMID: 32370836 DOI: 10.1016/j.mayocp.2020.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 03/12/2020] [Accepted: 03/18/2020] [Indexed: 11/21/2022]
Abstract
Primary care physicians are at the forefront of patient care and often are the first clinicians to triage and diagnose any eye-related complaints. They must be able to quickly identify vision-threatening pathologies, as delay in treatment of an ocular emergency can result in permanent vision loss. This concise review describes the definition, presentation, examination, and management of various ophthalmic emergencies including blunt ocular trauma, chemical ocular injury, orbital cellulitis, endophthalmitis, acute angle closure glaucoma, optic neuritis, giant cell arteritis, central retinal artery occlusion, retinal detachment, and homonymous hemianopia in a succinct manner.
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Affiliation(s)
- Saumya M Shah
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
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Harvey EC, Feng M, Ji X, Zhang R, Li Y, Chen GH, Li K. Impacts of photon counting CT to maximum intensity projection (MIP) images of cerebral CT angiography: theoretical and experimental studies. Phys Med Biol 2019; 64:185015. [PMID: 31315093 DOI: 10.1088/1361-6560/ab32fe] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
While CTA is an established clinical gold standard for imaging large cerebral arteries and veins, an important challenge that currently remains for CTA is its limited performance in imaging small perforating arteries with diameters below 0.5 mm. The purpose of this work was to theoretically and experimentally study the potential benefits of using photon counting detector (PCD)-based CT (PCCT) to improve the performance of CTA in imaging these small arteries. In particular, the study focused on an important component of the CTA image package known as the maximum intensity projection (MIP) image. To help understand how the physical properties of a detector quantitatively influence the MIP image quality, a theoretical model on the statistical properties of MIP images was developed. After validating this model, it was used to explore the individual and joint contribution of the following detector properties to the MIP signal-to-noise ratio (SNR): inter-slice noise covariance, spatial resolution along the z direction, and native pixel pitch along z. The model demonstrated that superior slice sensitivity, reduced inter-slice noise correlation, and smaller native pixel pitch along z provided by PCDs lead to improved vessel SNR in MIP images. Finally, experiments were performed by scanning an anthropomorphic cerebral angiographic phantom using a benchtop PCCT system and a commercial MDCT system. The experimental MIP results consistently demonstrated that compared with MDCT, PCCT provides superior vessel conspicuity and reduced artifactual stenosis.
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Affiliation(s)
- Evan Cary Harvey
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, United States of America
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Miyake Y, Morimoto Y, Taniguchi M, Yamanaka C, Ueno G, Ejima S, Yutani C. Giant cell arteritis without cranial manifestations caused mesenteric involvement: a case report. Surg Case Rep 2019; 5:119. [PMID: 31342194 PMCID: PMC6656821 DOI: 10.1186/s40792-019-0678-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/19/2019] [Indexed: 12/03/2022] Open
Abstract
Background Giant cell arteritis (GCA) is a granulomatous vasculitis and targets large vessels with predominance for the aortic arch and the cranial branches. GCA with cranial symptoms shows headache, jaw claudication, and ophthalmologic symptoms and thus was previously called temporal arteritis. Recently, cases of GCA without cranial manifestations and extracranial GCA have been reported. Case presentation A 76-year-old woman was referred to our hospital complaining of sudden abdominal pain and high fever. Her present history of illness did not show any cranial symptoms such as headache, visual disturbance, or stroke. CT images showed severe thickening of the small intestinal mesentery and massive ascites. She was diagnosed to have acute abdomen probably with gastrointestinal perforation and underwent the emergent laparotomy. Excisions of a 60-cm length of the jejunum including the thickening mesenteric lesion were carried out. Marked hypertrophy of the vascular intima and mild stenosis of the arterial lumen were displayed with infiltration of lymphocytes, neutrophils, and eosinophils. Scattered multinucleated giant cells on the endothelium, in the intima, media, and adventitia were demonstrated. Elastica van Gieson stain showed focal loss and fragmentation of the internal elastic lamina. Histopathological examinations showed typical GCA. Her postoperative process was uneventful without any symptoms, and she was followed as an out-patient prescribed with daily doses of 40 mg of prednisolone. Conclusions We hereby report a rare case of mesenteric involvement in GCA without cranial manifestations and elucidate the histopathological features of extracranial GCA in arteries as well as veins and jejunum.
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Affiliation(s)
- Yasuhiro Miyake
- Department of Surgery, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
| | - Yoshikazu Morimoto
- Department of Surgery, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan.
| | - Masaaki Taniguchi
- Department of Surgery, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
| | - Chihiro Yamanaka
- Department of Surgery, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
| | - Goro Ueno
- Department of Surgery, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
| | - Sakae Ejima
- Department of Pathology, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
| | - Chikao Yutani
- Department of Pathology, Japan Community Healthcare Organization (JCHO) Osaka Bay Central Hospital, 1-8-30 Chikko, Minato-ku, Osaka, 552-0021, Japan
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Chu X, Wang D, Zhang Y, Yin Y, Cao Y, Han X, Shen M, Jiang H, Zeng X. Comparisons of clinical manifestations and prognosis between giant cell arteritis patients with or without sensorineural hearing loss: A retrospective study of Chinese patients. Medicine (Baltimore) 2019; 98:e15286. [PMID: 31027087 PMCID: PMC6831369 DOI: 10.1097/md.0000000000015286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Auditory manifestations has rarely been mentioned in studies concerning giant cell arteritis (GCA). This study explores the proportion of hearing loss (HL) in Chinese GCA patients and investigates the differences in clinical features between GCA patients with and without HL.The study retrospectively reviewed the clinical records of 91 patients diagnosed with GCA at Peking Union Medical College Hospital (PUMCH) from November 1998 to October 2017. GCA diagnoses were reconfirmed according to the American College of Rheumatology 1990 criteria. Diagnosis of HL was made based on a patient's symptoms combined with physical examination or ear-nose-throat (ENT) audiometry tests. Subgroup analysis was conducted according to the occurrence of HL.Totally 23 patients (25.3%) had HL. A higher percentage of males (65.2% vs 38.2%, p = 0.025) was seen in HL group. Symptoms such as headache (91.3% vs 61.2%, p = 0.011), visual loss (56.5% vs 32.4%, p = 0.039) and CNS symptoms (39.1% vs 17.6%, p = 0.035) were more frequent in HL group. Moreover, they were more likely to have smoking history (p = 0.019), lower lymphocyte count (p = 0.049), positive ANA or APL (p = 0.047, p = 0.017) or negative biopsy results (p = 0.015). Symptom like myalgia (26.1% vs 66.2%, p = 0.001) as well as comorbid disease like coronary artery disease (p = 0.037) and hypertension (p = 0.040) was more frequent in patients without HL. Either C-reactive protein (90.91 ± 65.86 vs 76.05 ± 61.15 mg/L, p = 0.347) or erythrocyte sedition rate (83.04 ± 29.61 vs 93.69 ± 26.78 mm/h, p = 0.136) was high in both groups but the differences were not significant. Meanwhile, no significant differences were found in age, disease course, vascular involvement or prognosis between the two groups. Unilateral HL tended to happen at the same side with unilateral headache, visual loss, scalp tenderness or jaw claudication.HL is probably not rare in GCA patients and is more frequently to be seen in patients presented with headache, visual loss or CNS symptoms. Differentiation of HL is necessary for specialists and GCA should be considered as a potential diagnosis especially in HL patients with high inflammatory markers. Auditory assessment should be conducted in GCA management.
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Affiliation(s)
- Xiaotian Chu
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
| | - Dongmei Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Yun Zhang
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
| | - Yue Yin
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
| | - Yu Cao
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
| | - Xinxin Han
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
| | | | - Hong Jiang
- Department of Otorhinolaryngology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xuejun Zeng
- Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing
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16
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Skanchy DF, Vickers A, Prospero Ponce CM, Lee AG. Ocular manifestations of giant cell arteritis. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2018.1560265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- David F. Skanchy
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Aroucha Vickers
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
| | | | - Andrew G. Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Department of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Division of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Department of Ophthalmology, Texas A and M College of Medicine, College Station, TX, USA
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17
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Ribatti D, Tamma R, Ruggieri S, Annese T, Marzullo A, Crivellato E. Mast cells and primary systemic vasculitides. Microcirculation 2018; 25:e12498. [DOI: 10.1111/micc.12498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/09/2018] [Accepted: 08/13/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Roberto Tamma
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Simona Ruggieri
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Tiziana Annese
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs; University of Bari Medical School; Bari Italy
| | - Andrea Marzullo
- Department of Emergency and Organ Transplantation; University of Bari Medical School; Bari Italy
| | - Enrico Crivellato
- Department of Medicine, Human Anatomy Section; University of Udine Medical School; Udine Italy
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18
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Lee EJ, Woo KA, Koo DL. Giant Cell Arteritis Associated Arteritic Anterior Ischemic Optic Neuropathy: Sudden Vision Loss on the Contralateral Side of Headache. J Clin Neurol 2018; 14:577-579. [PMID: 30198237 PMCID: PMC6172488 DOI: 10.3988/jcn.2018.14.4.577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Eung Joon Lee
- Department of Neurology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Lim Koo
- Department of Neurology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea.
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19
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Watanabe A, Isono H, Shimada K, Chino Y. A typical case of giant cell arteritis with vision loss due to delayed diagnosis. J Gen Fam Med 2018; 19:139-140. [PMID: 29998045 PMCID: PMC6030035 DOI: 10.1002/jgf2.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 04/08/2018] [Indexed: 11/21/2022] Open
Abstract
A 75-year-old woman lost vision because of delayed recognition of GCA. Early diagnosis and treatment of GCA are important for preventing visual complications. Physicians must remember to evaluate the entire body, not just a single organ/system.
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Affiliation(s)
- Ami Watanabe
- Department of MedicineMito Kyodo General HospitalUniversity of TsukubaMitoIbarakiJapan
| | - Hiroki Isono
- Department of MedicineMito Kyodo General HospitalUniversity of TsukubaMitoIbarakiJapan
- Department of Primary Care and Medical EducationGraduate School of Comprehensive Human SciencesUniversity of TsukubaTsukubaIbarakiJapan
| | - Kaoru Shimada
- Department of MedicineMito Kyodo General HospitalUniversity of TsukubaMitoIbarakiJapan
| | - Yusuke Chino
- Department of RheumatologyMito Kyodo General HospitalUniversity of TsukubaMitoIbarakiJapan
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20
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Peral-Cagigal B, Pérez-Villar Á, Redondo-González LM, García-Sierra C, Morante-Silva M, Madrigal-Rubiales B, Verrier-Hernández A. Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis. Med Oral Patol Oral Cir Bucal 2018; 23:e290-e294. [PMID: 29680850 PMCID: PMC5945239 DOI: 10.4317/medoral.22298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 02/26/2018] [Indexed: 12/27/2022] Open
Abstract
Background Temporal artery biopsy (TAB) is a surgical procedure with a low positive yield. The purpose of this study is to determine which variables are the most important in the giant cell arteritis (GCA) diagnosis. The objective of this evaluation is to improve the percentage of positive temporal artery biopsy and if possible, avoid the biopsy in some cases. Material and Methods A retrospective clinical study consisted of 90 patients who had undergone TAB at the Río Hortega Hospital (Spain) from January 2009 to December 2016. Clinical findings, erythrocyte sedimentation rates (ESR) and other laboratory parameters, American College of Rheumatology (ACR) criteria for GCA score and biopsy results were recorded. Results Nineteen (21.1%) biopsies were positive for GCA. The mean age in positive TAB was 78.6 years old (SD 7.93), and 73.7% were female. Presence of temporal headache (p = 0.003), jaw claudication (p = 0.001), abnormal artery exploration (p = 0.023), elevated erythrocyte sedimentation rate (p = 0.035), CRP (p = 0.018) and platelets (p = 0.042), were significantly associated with GCA. Multivariate logistic regression revealed that the best predictors for the diagnosis of GCA are headache and jaw claudication, adjusted by sex, age, and temporal exploration. Conclusions TAB has benefit only for patients who score a 2 or 3 on the ACR criteria for GCA without biopsy. These findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis. Key words:Giant cell arteritis, horton arteritis, vasculitis, temporal artery biopsy, jaw claudication, temporal headache.
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Affiliation(s)
- B Peral-Cagigal
- Servicio Regional de Cirugía Oral y Maxilofacial, Hospital Universitario del Río Hortega, C/Dulzaina n 2, 47012 Valladolid, Spain,
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21
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Abstract
Headache, an almost universal human experience, is one of the most common complaints encountered in medicine and neurology. Described and categorized since antiquity, with the first classification by Aretaeus of Cappadocia, other classifications followed. The evaluation of this condition may be straightforward or challenging, and, though often benign, headache may prove to be an ominous symptom. This review discusses the current diagnosis and classification of headache disorders and principles of management, with a focus on migraine, tension-type headache, trigeminal autonomic cephalgias, and various types of daily headache.
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Affiliation(s)
- Paul Rizzoli
- Graham Headache Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, Mass
| | - William J Mullally
- Graham Headache Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, Mass.
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22
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Yoon HJ, Park SW, Lee HK, Choi YD, Heo H. Bilateral Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in Korea. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:466-467. [PMID: 28994270 PMCID: PMC5636726 DOI: 10.3341/kjo.2017.0089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hyeon Jeong Yoon
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Woo Park
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Kyun Lee
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hwan Heo
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
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23
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On alert for giant cell arteritis. Nursing 2017; 47:28-34. [PMID: 28463889 DOI: 10.1097/01.nurse.0000516217.09026.fe] [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]
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24
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Approach to giant cell arteritis and recent evidence on its relation with cardiovascular risk. A review. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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25
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Histologisch nachgewiesene Riesenzellarteriitis und Sehverlust. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0304-y] [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]
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26
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Kang YS, Park SW, Lee HK, Choi YD, Heo H. Arteritic Anterior Ischemic Optic Neuropathy Associated with Giant Cell Arteritis in an Elderly Korean Man. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:239-41. [PMID: 27247526 PMCID: PMC4878987 DOI: 10.3341/kjo.2016.30.3.239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yeon-Soo Kang
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Woo Park
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ho-Kyun Lee
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hwan Heo
- Department of Ophthalmology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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27
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Highlights in neuro-ophthalmology. Saudi J Ophthalmol 2015; 29:1-2. [DOI: 10.1016/j.sjopt.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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