Scalp ulceration: a rare manifestation of giant cell arteritis

Abstract

An 81-year-old woman presented with an enlarging, tender ulcer on her scalp over an 8-week period, attributing it to a prior graze with garden shears. C-reactive protein and erythrocyte sedimentation rate were elevated at 87.7 mg/L and 112 mm/hour, respectively. Incisional biopsies demonstrated ulceration and full thickness necrosis with no evidence of malignancy. Vasculitis was suggested as a likely cause of such extensive necrosis and subsequent temporal artery biopsy findings were consistent with giant cell arteritis. The patient was initially treated with high-dose oral prednisolone and achieved complete healing of the scalp necrosis within 12 months, with a gradual down-titration of steroid therapy thereafter. Scalp necrosis is a rare, potentially life-threatening complication of giant cell arteritis. This case highlights the importance of considering scalp necrosis as a manifestation of giant cell arteritis when assessing scalp ulceration. Prompt diagnosis and treatment can prevent significant morbidity and potential mortality.

Scalp Necrosis Revealing Severe Giant-Cell Arteritis

“…Its onset tends to be insidious over weeks to months and abrupt in up to 20% of patients [ 2 ]. It is generally accepted that it is related to not only a relatively advanced giant-cell arteritis [ 3 ] but also to a delay in diagnosis and initiation of effective treatment resulting in multivessel occlusion of all four main arteries supplying the temporal scalp [ 4 ]. It represents therefore an extreme therapeutic emergency as it can spread in depth resulting in a significant loss of substance with a risk of skull bone necrosis, irreversible visual loss, and severe tongue necrosis [ 5 ].…”

Localized livedo racemosa as an indicator for giant cell arteritis

“…The cranial manifestation of GCA is typically seen in elderly patients with new-onset headache and temporal artery abnormality (tenderness to palpation or decreased pulsation) accompanied by visual impairment or loss of vision and cutaneous erosions. 2 , 4 , 5 …”

Multiple Facial Ulcers Following a Stroke

“…1 Giant cell arteritis is a systemic vasculitis of the large and medium vessels that can lead to scalp necrosis. 4 However, the resulting ulceration is usually limited to the frontotemporal region and is accompanied by headache, visual disturbances, and jaw claudication. These symptoms were absent in this patient.…”