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Evangelatos G, Grivas A, Pappa M, Kouna K, Iliopoulos A, Fragoulis GE. Cranial giant cell arteritis mimickers: A masquerade to unveil. Autoimmun Rev 2022; 21:103083. [PMID: 35341973 DOI: 10.1016/j.autrev.2022.103083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
Giant cell arteritis (GCA) is a large-vessel vasculitis that affects cranial and extra-cranial arteries. Extra-cranial GCA presents mainly with non-specific symptoms and the differential diagnosis is very broad, while the cranial form has more typical clinical picture and physicians have a lower threshold for diagnosis and treatment. Although temporal artery biopsy (TAB) has an established role, ultrasound (US) is being increasingly used as the first-line imaging modality in suspected GCA. Vasculitides (especially ANCA-associated), hematological disorders (mainly amyloidosis), neoplasms, infections, atherosclerosis and local disorders can affect the temporal arteries or might mimic the symptoms of cranial GCA and produce US and TAB findings that resemble those of temporal vasculitis. Given that prompt diagnosis is essential and proper treatment varies significantly among these diseases, in this review we aimed to collectively present disorders that can masquerade cranial GCA.
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Affiliation(s)
- Gerasimos Evangelatos
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Alexandros Grivas
- Clinical Immunology-Rheumatology Unit, Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pappa
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Kouna
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - George E Fragoulis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, School of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Salvador Nunes L, Bart PA, Dunet V, Lu H. [Hypertrophic pachymeningitis revealing metastatic invasive lobular breast carcinoma]. Presse Med 2019; 48:1184-1187. [PMID: 31653539 DOI: 10.1016/j.lpm.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/14/2019] [Accepted: 09/09/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Luis Salvador Nunes
- Centre hospitalier universitaire vaudois, service de médecine interne, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Pierre-Alexandre Bart
- Centre hospitalier universitaire vaudois, service de médecine interne, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Vincent Dunet
- Centre hospitalier universitaire vaudois, service de radiodiagnostic et radiologie interventionnelle, Rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Henri Lu
- Centre hospitalier universitaire vaudois, service de médecine interne, rue du Bugnon 46, 1011 Lausanne, Suisse.
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Yao A, Jia L, Wang B, Zhang J, Zhang J, Xu B. Idiopathic Hypertrophic Pachymeningitis Mimicking Meningioma with Occlusion of Superior Sagittal Sinus: Case Report and Review of Literature. World Neurosurg 2019; 127:534-537. [PMID: 30965168 DOI: 10.1016/j.wneu.2019.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Idiopathic hypertrophic pachymeningitis is a rare inflammatory condition with diffuse thickening of the dura mater, which may cause a compressive effect or vascular compromise. CASE DESCRIPTION A 40-year-old Chinese man presented with persistent headache for 6 months and a sudden epileptic seizure 2 days ago. Magnetic resonance imaging demonstrated a large (71 × 34 × 27 mm) extra-axial mass at the right frontal convexity with severe edema mimicking meningioma. The lesion and peripheral dura mater showed contrast enhancement. Additionally, the skull near the lesion was eroded. Meningioma was diagnosed, and the patient underwent surgery. During the operation, we found the lesion texture was very tough, and the superior sagittal sinus was occluded. Histopathologic findings revealed a large number of infiltrated lymphocytes with fibrosis and microabscess formation; intracranial idiopathic hypertrophic pachymeningitis was diagnosed. Follow-up magnetic resonance imaging performed 3 months after surgery demonstrated the enhancement was notably alleviated. CONCLUSIONS Idiopathic hypertrophic pachymeningitis should be part of the differential diagnosis of some cases of meningioma.
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Affiliation(s)
- Anhui Yao
- Department of Neurosurgery, General Hospital of PLA, Beijing, China; Department of Neurosurgery, The 988 Hospital of PLA, Zhengzhou, China
| | - Liyun Jia
- Department of Medical Genetics and Cell Biology, School of Basic Medical Science, Zhengzhou University, Zhengzhou, China
| | - Benhan Wang
- Department of Neurosurgery, The 988 Hospital of PLA, Zhengzhou, China
| | - Jiashu Zhang
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Jun Zhang
- Department of Neurosurgery, General Hospital of PLA, Beijing, China.
| | - Bainan Xu
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
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Koura T, Kita K, Konishi H. A case of suspected MPO-ANCA-related hypertrophic pachymeningitis with atypical presentation. J Gen Fam Med 2017; 18:409-410. [PMID: 29264073 PMCID: PMC5729363 DOI: 10.1002/jgf2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/09/2016] [Indexed: 11/22/2022] Open
Abstract
A 66‐year‐old man presented to our emergency department with acute consciousness disorder, headache, and fever. Initial laboratory data indicated a high level of inflammatory reaction. Enhanced magnetic resonance imaging revealed a thickening of the right cranial dura mater on T1‐weighted images. We presumed the patient was diagnosed as having myeloperoxidase antineutrophil cytoplasmic antibody (MPO‐ANCA)‐related hypertrophic pachymeningitis (HP). Acute impaired consciousness without focal signs is an unusual presentation of HP. This treatable disease should be considered as a differential diagnosis when a patient presents with drowsiness and headache.
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Affiliation(s)
- Tomoyuki Koura
- Department of Toyama Primary Care; University of Toyama School of Medicine; Toyama Japan
| | - Keiichiro Kita
- Department of General Medicine; Toyama University Hospital; Toyama Japan
| | - Hirofumi Konishi
- Department of Neurology; Toyama University Hospital; Toyama Japan
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Sato M, Kodaira M, Ishii W, Nakagawa M, Kishida D, Miyazaki D, Shimojima Y, Matsuda M, Uehara T, Ikeda SI. Multifocal Fibrosclerosis with Hypertrophic Pachymeningitis and a Soft Tissue Mass around the Thoracic Vertebral Bodies: A Case Report with Review of the Literature. Intern Med 2015; 54:2267-72. [PMID: 26328659 DOI: 10.2169/internalmedicine.54.3230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Multifocal fibrosclerosis is the term used to represent a combination of similar fibrous lesions occurring at different anatomical sites. We herein report a hypertrophic pachymeningitis patient with a soft tissue mass around the thoracic vertebral bodies. A histopathological analysis of the biopsied tissues from both lesions showed dense fibrosis and a marked infiltration of lymphocytes and plasma cells, which lead to the diagnosis of multifocal fibrosclerosis. This pathological condition closely resembles that of IgG4-related disease and is a very rare combination of manifestations. Our case suggests that hypertrophic pachymeningitis patients need to also undergo a whole body examination.
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Affiliation(s)
- Mitsuto Sato
- Department of Internal Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
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Ramirez L, D'Auria A, Popalzai A, Sanossian N. Bilateral Vision Loss Secondary to Pachymeningitis in a Patient with IgG4-Related Disease. Front Neurol 2014; 5:192. [PMID: 25352825 PMCID: PMC4195318 DOI: 10.3389/fneur.2014.00192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/15/2014] [Indexed: 12/24/2022] Open
Abstract
IgG4-related disease (IgG4-RD) is a recently recognized fibroinflammatory condition associated with disease in nearly every organ, including the meninges. A proportion of idiopathic hypertrophic pachymeningitis cases may involve a component of meningeal IgG4-RD. We present a patient with severe bilateral vision loss found to have thickening of the dura mater on MRI, and subsequently diagnosed with IgG4-RD after dural biopsy.
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Affiliation(s)
- Lucas Ramirez
- Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California , Los Angeles, CA , USA
| | - Andrea D'Auria
- Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California , Los Angeles, CA , USA
| | - Adeel Popalzai
- Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California , Los Angeles, CA , USA
| | - Nerses Sanossian
- Roxanna Todd Hodges Comprehensive Stroke Clinic, University of Southern California , Los Angeles, CA , USA
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Optic neuropathy caused by Propionibacterium acnes pachymeningitis. J Neuroophthalmol 2014; 34:264-7. [PMID: 24614085 DOI: 10.1097/wno.0000000000000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe a patient with vision loss from an optic neuropathy caused by Propionibacterium acnes pachymeningitis. The patient's optic neuropathy was stabilized with appropriate antibiotic therapy.
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Diener HC, Johansson U, Dodick DW. Headache attributed to non-vascular intracranial disorder. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:547-587. [PMID: 20816456 DOI: 10.1016/s0072-9752(10)97050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This chapter deals with non-vascular intracranial disorders resulting in headache. Headache attributed to high or low cerebrospinal fluid pressure is separated into headache attributed to idiopathic intracranial hypertension (IIH), headache attributed to intracranial hypertension secondary to metabolic, toxic, or hormonal causes, headache attributed to intracranial hypertension secondary to hydrocephalus, post-dural puncture headache, cerebrospinal fluid (CSF) fistula headache, headache attributed to spontaneous (or idiopathic) low CSF pressure. Headache attributed to non-infectious inflammatory disease can be caused by neurosarcoidosis, aseptic (non-infectious) meningitis or lymphocytic hypophysitis. Headache attributed to intracranial neoplasm can be caused by increased intracranial pressure or hydrocephalus caused by neoplasm or attributed directly to neoplasm or carcinomatous meningitis. Other causes of headache include hypothalamic or pituitary hyper- or hyposecretion and intrathecal injection. Headache attributed to epileptic seizure is separated into hemicrania epileptica and post-seizure headache. Finally headache attributed to Chiari malformation type I (CM1) and the syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) are described.
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Néel A, Agard C, Chevalet P, Moreau A, Hamidou M. [Skull metastase masquerading as temporal arteritis: report of two cases]. Rev Med Interne 2008; 30:340-4. [PMID: 19026471 DOI: 10.1016/j.revmed.2008.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Revised: 09/21/2008] [Accepted: 10/05/2008] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Temporal arteritis is the most common systemic vasculitis of the elderly. A definitive diagnosis is obtained on temporal artery biopsy examination (TAB). However, 30% of TAB yields false negative results. In such cases, diagnosis relies on clinical presentation and exclusion of alternative diagnosis. Conversely, false positive TAB are uncommon. CASE REPORTS We report two patients who presented with headache, scalp tenderness and increased acute phase reactants, suggesting temporal arteritis, but which turned out to reveal a skull metastase. Temporal artery biopsy performed in one case demonstrated arterial wall inflammation. CONCLUSION Clinicians must be aware that a skull lesion can mimick temporal arteritis.
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Affiliation(s)
- A Néel
- Service de médecine interne, CHU Hôtel-Dieu, place Alexis-Ricordeau, 44000 Nantes, France.
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