A Review of the Dermatological Complications of Giant Cell Arteritis

Abstract

Giant cell arteritis (GCA) is characterized by granulomatous inflammation of large and medium-sized vessels. It is the most common vasculitis among elderly people in Europe and North America. GCA usually presents with ischemic cranial manifestations such as headache, scalp tenderness, visual manifestations, and claudication of the tongue and jaw. Thickness and tenderness of temporal arteries are the most recognizable signs of GCA on physical examination. Laboratory tests usually show raised acute phase reactants. Skin manifestations are uncommon in GCA and are rarely found as a presenting symptom of GCA. Necrosis of the scalp and tongue is the most common ischemic cutaneous manifestation of GCA. Although infrequent, when present it reflects severe affection and poor prognosis of GCA. Panniculitis-like lesions have been reported in the setting of GCA, with nodules being the most common finding. Other entities, such as generalized granuloma annulare or basal cell carcinoma have been occasionally described in GCA patients. Prompt recognition and initiation of therapy are crucial to prevent serious complications of GCA. When high suspicion of GCA exists, immediate administration of glucocorticoids is recommended. It is advisable to refer the patient to a specialist GCA team for further multidisciplinary assessment.

Sarcoidal Granuloma Annulare–Like Dermatitis and Vasculitis With Granulomatous Features: An Atypical Case of Giant Cell Arteritis

“…Cutaneous manifestations of GCA are rare. 4,15 Of those found in the literature, 4 cases reported generalized GA in association with GCA, and 1 reported vasculitis with granulomatosis on histopathology, similar to our patient. [4][5][6][7][8][9] All 4 cases reported generalized GA, and in 3 of the 4 cases, GA preceded the classic symptoms of GCA.…”

“…4,15 Of those found in the literature, 4 cases reported generalized GA in association with GCA, and 1 reported vasculitis with granulomatosis on histopathology, similar to our patient. [4][5][6][7][8][9] All 4 cases reported generalized GA, and in 3 of the 4 cases, GA preceded the classic symptoms of GCA. [6][7][8][9] Neurologic symptoms of GCA occurred within 1 month up to 1 year from the cutaneous eruptions, raising the possibility that it may be a harbinger of impending disease.…”

“…2,3 Although rare, the most common dermatologic findings are ischemic lesions of the head and neck, including scalp ulcers and glossitis, which can progress to necrosis of the scalp or tongue. 3,4 Other cutaneous manifestations including granuloma annulare (GA) and vasculitis with granulomatosis have been described in association with GCA. [5][6][7][8][9] We present an atypical case of GCA with the co-occurrence of 2 distinct cutaneous morphologies preceding the classic neurologic symptoms.…”

Atypical giant cell arteritis presentations diagnosed with FDG-18 whole body PET imaging

“…Atypical presentations of GCA can also present with undifferentiated constitutional symptoms (pyrexia of unknown origin (PUO), fatigue, weight loss) and organ-related ischaemia or inflammatory disorders including mucocutaneous (lingual and scalp necrosis, panniculitis),7–12 neurological (mononeuritis multiplex, cerebral vasculitis, cranial nerve palsies, acute stroke),13–17 ocular (uveitis, choroidal infarction),18–21 musculoskeletal (peripheral joint arthritis, focal myositis)22–24 and inflammatory pseudotumour (skin, uterine, breast),25–28 along with orchitis, myocardial infarction and mesenteric ischaemia 29–32…”

Updates in cutaneous manifestations of systemic vasculitis

“…Cutaneous manifestations in giant cell arteritis (GCA) remain to be uncommon and are rarely reported to be the presenting sign of the disease. In their recent review, Prieto-Peña et al in 2019, classified the cutaneous manifestations of GCA into three categories based on their nature: ischemic mucocutaneous manifestations including scalp, tongue and lip necrosis; nodules and panniculitis-like lesions including erythema nodosum-like lesions; diseases associated with GCA, such as generalized granuloma annulare and basal cell carcinoma [5 ▪ ] (Fig. 1a).…”