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De Fontcuberta P, Vandenhende MA, Laux M, Tourbier B, Paz R, Bonnet F, Meriglier E. [Hearing loss in giant cell arteritis: A case report]. Rev Med Interne 2023; 44:31-34. [PMID: 35752483 DOI: 10.1016/j.revmed.2022.05.008] [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: 04/15/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Hearing loss is a rare manifestation in giant cell arteritis. The different types of deafness are possible with a predominance of sensorineural deafness. CASE REPORT We report a 75-year-old woman who presented with typical manifestations of giant cell arteritis associated concomitantly with the occurrence of bilateral mixed hearing loss confirmed on the audiogram. Corticosteroids allowed a rapidly favorable clinical and biological outcome. The follow-up audiogram at 3 months was markedly improved and showed a decrease in sensorineural hearing loss and disappearance of conductive hearing loss. CONCLUSION Any rapid onset deafness in an inflammatory context in the elderly should lead to a search for giant cell arteritis. The diagnosis can be difficult in the absence of other typical manifestations, especially since the biopsy of the temporal artery most often comes back negative. Corticosteroids are usually effective.
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Affiliation(s)
- Pedro De Fontcuberta
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France
| | - Marie-Anne Vandenhende
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France; Université de Bordeaux, Talence, France
| | - Miranda Laux
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France
| | - Benjamin Tourbier
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France
| | - Rafael Paz
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France
| | - Fabrice Bonnet
- Université de Bordeaux, Talence, France; Service de médecine interne et maladies infectieuses, hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - Etienne Meriglier
- Service de médecine interne et post-urgences, hôpital Pellegrin, CHU de Bordeaux, hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux, France; Université de Bordeaux, Talence, France.
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Shi YF, Malik S. A Giant Silence - An atypical association of sensorineural hearing loss with Giant Cell Arteritis. Int J Rheum Dis 2022; 25:1203-1207. [PMID: 35880512 PMCID: PMC9796047 DOI: 10.1111/1756-185x.14401] [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: 06/15/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 12/30/2022]
Abstract
Giant cell arteritis (GCA) is a chronic vasculitic disorder predominantly affecting medium to large sized arteries, prevalent in the 50 plus age group. This case illustrates an atypical presentation of this disease in the form of bilateral sensorineural hearing loss (SNHL). Apart from the presence of constitutional and vertiginous symptoms, there were essentially no classical features of GCA. Differentials were broad including infection, malignancy and medication toxicity as well as brain, eye and ear syndromes such as Cogan's syndrome, all of which were eventually excluded. Her diagnosis was ultimately confirmed on positron emission tomography, which highlights the diagnostic importance of this modality. She was managed with corticosteroids then tocilizumab and is making a gradual recovery. Literature review demonstrates that SNHL is more prevalent than previously suggested in GCA, although this does not have widespread recognition. Mechanisms of SNHL in GCA include vascular occlusion, immunological mechanisms including cross reactivity with viral antigens and direct viral infection. SNHL does appear to improve with corticosteroids. This case emphasizes the importance of considering GCA as an important differential in SNHL.
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Affiliation(s)
- Yu Feng Shi
- Concord HospitalSydneyNew South WalesAustralia
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3
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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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4
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Junejo S, Ali Y, Abrudescu A. Giant Cell (Temporal) Arteritis with Persistent Bilateral Sensorineural Hearing Loss - A Likely Consequence of Delayed Institution of Glucocorticoid Therapy. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1233-1237. [PMID: 29186088 PMCID: PMC5706380 DOI: 10.12659/ajcr.907174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 66 Final Diagnosis: Giant cell arteritis Symptoms: Hearing loss Medication: — Clinical Procedure: — Specialty: Rheumatology
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Affiliation(s)
- Shoaib Junejo
- , Icahn School of Medicine at Mount Sinai-Queens Hospital Center, Jamaica, NY, USA
| | - Yasir Ali
- Department of Endocrinology, NYC Health and Queens Hospital Center, Jamaica, NY, USA
| | - Adriana Abrudescu
- , Icahn School of Medicine at Mount Sinai-Queens Hospital Center, Jamaica, NY, USA
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6
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Abstract
OBJECTIVES The association of temporal arteritis and sensorineural hearing loss is a rare occurrence. We present four cases with both these disorders. METHODS A 10-year retrospective review of all cases seen at the Geisinger Medical Center showed 271 cases of temporal arteritis and four cases with concomitant sensorineural hearing loss. The four cases were identified, obtained, and extensively reviewed. Patients ranged in age from 59 to 76 years and presented with sensorineural hearing loss and signs, symptoms, and biopsy evidence of temporal arteritis. The response to therapy and clinical course of each case are discussed. RESULTS In three patients, the hearing loss preceded the diagnosis of giant cell arteritis by 2 days to 2 months. In one case, the hearing loss was noted concurrently with systemic features of giant cell arteritis. All cases were treated with corticosteroids and had full or partial return of hearing. CONCLUSIONS Sensorineural hearing loss can be a preceding or concurrent symptom of temporal arteritis. Recognition and treatment may lead to partial or full recovery. It is not certain whether the time from onset of hearing loss to diagnosis to institution of therapy influences recovery.
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Affiliation(s)
- R C Hausch
- Geisinger Medical Center, Department of Rheumatology, Danville, PA 17822, USA
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7
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Marcos O, Cebrecos AI, Prieto A, Sancho de Salas M. Tongue necrosis in a patient with temporal arteritis. J Oral Maxillofac Surg 1998; 56:1203-6. [PMID: 9766549 DOI: 10.1016/s0278-2391(98)90772-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- O Marcos
- Department of Maxillofacial Surgery, Ramón y Cajal University Hospital, Madrid, Spain
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8
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Llorente Pendás S, De Vicente Rodríguez JC, González García M, Junquera Gutierrez LM, López Arranz JS. Tongue necrosis as a complication of temporal arteritis. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1994; 78:448-51. [PMID: 7800375 DOI: 10.1016/0030-4220(94)90036-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Tongue necrosis is a rare complication in giant cell arteritis, an entity in which both temporal arteritis and rheumatic polymyalgia may be included as two different manifestations of the same pathologic process. The case of a 79-year-old patient who had tongue necrosis 3 hours after ingestion of 2 mg of ergotamine tartrate is presented. This complication was the basis for the diagnosis of temporal arteritis. We reviewed possible clinical manifestations of temporal arteritis and cases of tongue necrosis in the world literature. The possible existence of triggering factors that seemed to be present in 11 of the published cases was analyzed. In seven of these cases ingestion of ergotamine derivates had taken place.
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Affiliation(s)
- S Llorente Pendás
- Department of Oral and Maxillofacial Surgery, Hospital Central Universitario de Asturias, Spain
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9
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Simms RW, Zerbini CAF. Rheumatic Disease in the Intensive Care Unit: Acute Septic Arthritis and Giant-Cell Arteritis. J Intensive Care Med 1993. [DOI: 10.1177/088506669300800601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Robert W. Simms
- Arthritis Section, Boston University School of Medicine, Department of Medicine, and Thorndike Memorial Laboratories, Boston City Hospital, Boston, MA
| | - Cristiano A. F. Zerbini
- Arthritis Section, Boston University School of Medicine, Department of Medicine, and Thorndike Memorial Laboratories, Boston City Hospital, Boston, MA
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10
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Scully C, Eveson JW, Barrett AW, Cunningham SJ. Necrosis of the lip in giant cell arteritis: report of a case. J Oral Maxillofac Surg 1993; 51:581-3. [PMID: 8478767 DOI: 10.1016/s0278-2391(10)80519-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- C Scully
- Centre for the Study of Oral Disease, Bristol Dental Hospital and School, UK
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11
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Patterson A, Scully C, Barnard N, Griffiths MJ, Eveson JW, Novelli M. Necrosis of the tongue in a patient with intestinal infarction. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1992; 74:582-6. [PMID: 1437062 DOI: 10.1016/0030-4220(92)90348-t] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A patient with a rare combination of bilateral lingual necrosis and intestinal infarction, caused by giant cell arteritis, is described and the literature reviewed.
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Affiliation(s)
- A Patterson
- University Department of Oral Medicine, Surgery, and Pathology, Bristol Dental Hospital and School, England
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12
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Affiliation(s)
- M M Rubin
- Department of Oral and Maxillofacial Surgery, Nassau County Medical Center, East Meadow, NY
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13
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Friedlander AH, Runyon C. Polymyalgia rheumatica and temporal arteritis. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1990; 69:317-21. [PMID: 2138275 DOI: 10.1016/0030-4220(90)90292-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Polymyalgia rheumatica and temporal arteritis are separate but overlapping rheumatic diseases commonly seen among elderly persons. Polymyalgia rheumatica is characterized by upper body and trunk myalgias/arthralgias and an elevation in erythrocyte sedimentation rate. In about half of patients, temporal arteritis begins after polymyalgia rheumatica. Temporal arteritis is a systemic granulomatous disease that predominantly affects branches of the carotid artery. Claudication of the muscles of mastication and a painful burning tongue may develop during temporal arteritis or be the initial presenting symptoms. Recognition that these orofacial manifestations may be part of the disease process is mandatory because one third of patients with untreated temporal arteritis may go blind.
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14
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Sonnenblick M, Nesher G, Rosin A. Nonclassical organ involvement in temporal arteritis. Semin Arthritis Rheum 1989; 19:183-90. [PMID: 2557671 DOI: 10.1016/0049-0172(89)90031-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M Sonnenblick
- Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel
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15
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Abstract
An unusual case of temporal arteritis presenting with sensorineural hearing loss is presented. Deafness was improved dramatically by corticosteroid treatment. The diagnosis of temporal arteritis should be considered in elderly patients presenting with sensorineural hearing loss.
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Affiliation(s)
- M R Kramer
- Department of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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16
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Ferguson BJ, Allen NB, Farmer JC. Giant cell arteritis and polymyalgia rheumatica. Review for the otolaryngologist. Ann Otol Rhinol Laryngol 1987; 96:373-9. [PMID: 3619280 DOI: 10.1177/000348948709600404] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patients suspected of giant cell arteritis or polymyalgia rheumatica are often referred to the otolaryngologist for temporal artery biopsy. These patients may initially present to the otolaryngologist with symptoms referable to the head and neck. A comprehensive review of these two interrelated disorders is provided, with emphasis on head and neck manifestations and features of obtaining the temporal artery biopsy specimen.
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Bowdler DA, Knight JR. Lingual claudication and necrosis as a complication of giant cell arteritis. J Laryngol Otol 1985; 99:417-20. [PMID: 4009046 DOI: 10.1017/s0022215100096973] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A case of lingual claudication and necrosis of the tongue due to giant cell arteritis, treated by a high dose of Prednisolone, is reported.
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19
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Abstract
Temporal arteritis, or cranial arteritis, is a granulomatous arteritis with the common presenting manifestations of headache and visual loss. The disease is generally limited to elderly individuals; its pathogenesis is unknown, but may be of an immunological nature. Although otolaryngologic manifestations of the disease are common, few reports have been published. Visual loss is one of the most serious complications. Tongue necrosis has been reported in only 23 cases. We report a case of tongue necrosis and partial visual field loss in a patient with temporal arteritis. These complications were probably released by ergotamine tartrate administered because of migrainoid headache. This particular complication has been described only once previously.
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Abstract
Giant-cell arteritis is a polysymptomatic disease of the elderly. Systemic symptomatology includes headaches, arthralgias, myalgias, tender temporal arteries, jaw claudication, low-grade fever, anemia, anorexia, malaise, and weight loss. Visual loss from anterior ischemic optic neuropathy and diplopia resulting from ischemia of the ocular muscles represents the major ocular manifestations of giant cell arteritis. When the diagnosis is suspected, blood for a sedimentation rate should be drawn, and, if it confirms the clinical impression, high dose prednisone should be started immediately and a temporal artery biopsy performed at a later date. Only by asking the proper questions and suspecting the diagnosis will this preventable form of blindness receive the prompt attention it deserves.
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Abstract
A case of giant cell arteritis presenting with acute hearing loss which was reversed by corticosteroid therapy is described
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