Myocardial Infarction, Aortitis and Celiac Trunk Inflammation in Giant Cell Arteritis: A Case Report

Abstract

We report a rare case of a 62-year-old woman admitted for investigation of unexplained inflammatory syndrome. Her atypical clinical presentation included a lack of headache and systemic signs. Computed tomography scan showed thoracic, abdominal aortitis and celiac trunk inflammation. A temporal artery biopsy was consistent with giant cell arteritis (GCA). She was treated with corticosteroids with a good response. Her unusual clinical presentation highlights the importance of considering GCA in the causes of aortitis and myocardial infarction in patients over 50 years, where prompt corticosteroid treatment results in satisfactory outcomes.Retrosternal pain appeared on 7th day of hospitalization. An electrocardiogram revealed sinus rhythm of 75 beats/minute and ST-segment elevations in leads V1 to V5. Laboratory tests showed increased total plasma creatine kinase activity 561 U/l (normal range 25-195 U/l), and the blood troponin I level rose to 0.57μg/l 4 hour later (normal values < 0.1 μg/l).Because coronary vasculitis was suspected, intravenous administration of unfractioned heparin and acetylsalicylic acid were initiated and resulting in a relief of the chest pain and resolution of ST segment changes on electrocardiogram within 24 hours. Echocardiogram revealed hypokinesia of the apical segment of the anterior wall, as well as diminished left ventricular ejection fraction of approximately 45%. Coronary angiography performed later revealed no significant lesion.On discharge, corticosteroid therapy was continued and tapered 6 weeks later. The patient did not experience further episodes of chest pain or other cardiovascular complications during 1year of follow-up. IntroductionFew cases of acute coronary events are related to non atherosclerotic processes, such as coronary embolism, dissection, congenital abnormalities and vasculitis [1]. Giant cell arteritis (GCA) affects mainly arteries of large and medium caliber, especially the extra-cranial branches of the carotids. It may rarely affect coronary vessels [1][2][3][4][5][6][7][8][9][10][11][12].Although easily identified if a patient presents with typical symptoms, this diagnosis may often be complicated if the condition shows atypical clinical features.We report a case of a woman diagnosed with aortitis, celiac trunk inflammation and an acute myocardial infarction due to coronary vasculitis secondary to GCA. Case ReportA 62-year-old woman with 4 day history of moderate headaches was admitted to the department of Internal Medicine for investigation. On admission, her pulse rate 74 beats/min, arterial blood pressure was 110/70 mmHg, symmetrical over upper and lower extremity arteries. All peripheral pulses were present. The remaining physical examination was normal.Laboratory tests showed hemoglobin 8.5 g/dl, white blood cell count 10250/mm3, erythrocyte sedimentation rate was 124 mm/hour, and level of C -reactive protein was 59 mg/l, serum fibrinogen concentration 5.4 g/l, serum albumin level 36 g/l and an increased serum globulin 16.8 g/l. Other laborat...