Lingual necrosis leading to the diagnosis of giant cell arteritis

Abstract

Giant cell arteritis (GCA) is a chronic vasculitis comprising large-and mediumsized arteries branches originating from the aortic arch. GCA diagnosis might be challenging due to its several clinical characteristics. This clinical report describes a case of a 91-year-old woman who was admitted with tongue necrosis.Medical history revealed mild headache episodes and jaw numbness. Summing up clinical and laboratory findings, the diagnosis of GCA was established. Surgical debridement and corticotherapy led to complete resolution of the tongue lesion with no need for any additional intervention. In this case report, we highlight the importance of GCA early diagnosis in order to avoid more serious complications. INTRODUCTIONGiant cell arteritis (GCA) is, also known as temporal arteritis, characterized as a vasculitis that affects arteries (medium and large), mainly the branches of the internal and external carotid arteries and the temporal artery. 1,2 GCA has an incidence of approximately 20 cases per 100,000 individuals and a prevalence of one case per 500 individuals. 3 The disease affects mostly females (1.4-3 women for every man) over 50 years with mean age around 70 years. [2][3][4] GCA pathophysiology comprises wall vessels inflammation leading to arterial occlusion and tissue ischemia. 5 Main symptoms include muscle fatigue, headache, and visual alterations such as asdiplopia, amaurosis fugx, and loss of vision. Uncommon symptoms can be observed in some patients, such as tongue necrosis, which makes early diagnosis difficult. 1 Ulcers or tongue necrosis, resulting from giant cell vasculitis, are extremely rare, mainly due to the excellent