Lingual claudication and necrosis as a complication of giant cell arteritis

Giant cell arteritis affecting the tongue: a case report and review of the literature

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.

Tongue necrosis in temporal arteritis provoked by ergotamine

A case of tongue necrosis in a patient with temporal arteritis who was taking ergotamine is described, and the role of ergotamine tartrate in provoking the tongue necrosis is considered. The literature on this unusual complication is critically reviewed, and the value of a carotid angiography in assessing the tongue ischaemia is exemplified.

Necrosis of the tongue in a patient with intestinal infarction

A patient with a rare combination of bilateral lingual necrosis and intestinal infarction, caused by giant cell arteritis, is described and the literature reviewed.

Clinical and laboratory findings with giant cell arteritis

Out of 66 patients who were diagnosed as suffering from polymyalgia rheumatica (PMR; n = 40), temporal arteritis (AT; n = 14) or both (n = 12) in a 6.5 year period (incidence 3.4/100,000 per year), 9 died and 49 were followed up for an average period of 28 months. Exacerbations of the illness (n = 24) and complications in the course (n = 32) were more frequent with an initial ESR greater than 90 mm/h. Postural vertigo (n = 11), amaurosis fugax (n = 11) and polyneuropathy (n = 8) were the most frequent neurological complications. Persisting unilateral blindness and aromatic anosmia developed in 2 patients each. Complications were significantly more frequent in patients with initial symptoms of AT (chi 2 P less than 0.001). CRP-levels correlated better with persisting symptoms in the course than did the ESR. Recurrences after treatment were significantly more frequent when the length of corticosteroid-therapy was less than 20 months (chi 2 P less than 0.009). On follow up there were normal values for neopterin, tumour necrosis factor and antibodies against Borrelia burgdorferi.