SUMMARY An elderly man developed temporal arteritis and polymyalgia rheumatica with coexisting biochemical abnormalities of liver function. Biopsy revealed hepatic changes which have not been previously reported. There was hepatocellular necrosis and inflammation together with a prominent hyperplasia of perisinusoidal lipocytes of Ito. Temporal artery biopsy confirmed the presence of granulomatous panarteritis. Corticosteroid therapy produced rapid resolution of symptoms and reversion of liver function tests to normal.The association of giant cell (temporal) arteritis with polymyalgia rheumatica is well recognised.'Most workers now accept polymyalgia rheumatica as a clinical manifestation of giant cell arteritis,2 3 and temporal arteritis has also been observed following treatment of polymyalgia rheumatica.Little is known about the systemic effects of giant cell arteritis. Lesions of the myocardium, kidneys, gastrointestinal tract, and nervous system have been attributed to underlying arteritis.5 Changes in liver function tests have frequently been documented. These changes have been variable, with elevation of alkaline phosphatase being the most frequent abnormality.6 7 The histology of liver biopsies from these patients has mainly been normal.2 In some instances nonspecific fatty change was found,8 and single granulomas were described in 2 cases.7 9 We report a case of giant cell arteritis with hepatocellular necrosis and hyperplasia of perisinusoidal lipocytes of Ito, histological changes which hitherto have not been described in this syndrome. Case reportA 64-year-old man presented with a 3-month history of right-sided intermittent facial pain. His headache and facial pain became continuous and were asso-