Atypical Presentation of Giant Cell Arteritis: Case Report

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Main Author:	RAFAEL CONTRERAS ACOSTA
Format:	Artículo científico
Language:	en
Published:	Universidad del Norte 2024
Subjects:	Salud vasculitis giant cell arteritis magnetic resonance angiography Computed tomography angiography
Online Access:	Acceder al recurso 1 Acceder al recurso 2 Acceder al recurso 3 Acceder al recurso 4 Acceder al recurso 5
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author	RAFAEL CONTRERAS ACOSTA
author_facet	RAFAEL CONTRERAS ACOSTA
contents	Atypical Presentation of Giant Cell Arteritis: Case Report RAFAEL CONTRERAS ACOSTA ALFONSO SPATH SPATH ERIKA MARTÍNEZ CARREÑO CAMILO JOSÉ ALMANZA GLORIA MARINA PEDROSA ALGARIN JAVIER GONZÁLEZ QUIROGA MARÍA CASTRO PEREIRA Salud vasculitis giant cell arteritis magnetic resonance angiography Computed tomography angiography Giant cell arteritis (GCA) is a granulomatous vasculitis of medium and large arteries that usually affects the aorta and/or its main branches. We report a 66-year-old, female, black, and an active smoker patient. The patient consulted due to diffuse abdominal pain, nausea, vomiting, without neurological manifestations suggestive of intracranial involvement. Vital signs within acceptable limits, pain on palpation in the epigastrium and left flank, and positive renal fist percussion. Computed tomography (CT) angiography showed intramural inflammatory lesions and Stanford type B aortic dissection; therefore, transfer to the intensive care unit was indicated. Vascular surgery suggested intramural hematoma of the descending aorta and ulcer adjacent to the minor celiac trunk. Oral beta-blocker was started. Markers and an electrocardiogram were taken without findings of acute coronary cause. Control CT angiography showed thickening of the aortic walls from the arch to the bifurcation consistent with aortitis with elevated acute phase reactants. Pain improved and the patient was transferred to the general ward. Control images indicated suspicion of GCA vasculitis, so management with corticosteroids was started. Patient reported pain again, and a magnetic resonance (MRI) angiography was requested. It showed diffuse and concentric thickening of the aortic walls from the arch to the bifurcation. This suggested an inflammatory process of the aortic wall. After 7 days of treatment with prednisolone, patient was discharged due to decreased pain and no recurrence of other symptoms. Medication was indicated to continue, and a control MRI angiography was requested. Significant pain and imaging improvement was found, so the corticosteroid dose was tapered until it was discontinued. 2024 otro 0120-5552 https://www.redalyc.org/articulo.oa?id=81782334026 https://www.redalyc.org/journal/817/81782334026/ https://www.redalyc.org/journal/817/81782334026/html/ https://www.redalyc.org/journal/817/81782334026/81782334026.epub https://www.redalyc.org/journal/817/81782334026/movil 10.14482/sun.40.03.103.524 en http://www.redalyc.org/revista.oa?id=817 Salud Uninorte application/pdf Universidad del Norte Salud Uninorte (Colombia) Num.3 Vol.40
format	Artículo científico
id	redalyc_81782334026
language	en
publishDate	2024
publisher	Universidad del Norte
spellingShingle	Atypical Presentation of Giant Cell Arteritis: Case Report RAFAEL CONTRERAS ACOSTA Salud vasculitis giant cell arteritis magnetic resonance angiography Computed tomography angiography Atypical Presentation of Giant Cell Arteritis: Case Report RAFAEL CONTRERAS ACOSTA ALFONSO SPATH SPATH ERIKA MARTÍNEZ CARREÑO CAMILO JOSÉ ALMANZA GLORIA MARINA PEDROSA ALGARIN JAVIER GONZÁLEZ QUIROGA MARÍA CASTRO PEREIRA Salud vasculitis giant cell arteritis magnetic resonance angiography Computed tomography angiography Giant cell arteritis (GCA) is a granulomatous vasculitis of medium and large arteries that usually affects the aorta and/or its main branches. We report a 66-year-old, female, black, and an active smoker patient. The patient consulted due to diffuse abdominal pain, nausea, vomiting, without neurological manifestations suggestive of intracranial involvement. Vital signs within acceptable limits, pain on palpation in the epigastrium and left flank, and positive renal fist percussion. Computed tomography (CT) angiography showed intramural inflammatory lesions and Stanford type B aortic dissection; therefore, transfer to the intensive care unit was indicated. Vascular surgery suggested intramural hematoma of the descending aorta and ulcer adjacent to the minor celiac trunk. Oral beta-blocker was started. Markers and an electrocardiogram were taken without findings of acute coronary cause. Control CT angiography showed thickening of the aortic walls from the arch to the bifurcation consistent with aortitis with elevated acute phase reactants. Pain improved and the patient was transferred to the general ward. Control images indicated suspicion of GCA vasculitis, so management with corticosteroids was started. Patient reported pain again, and a magnetic resonance (MRI) angiography was requested. It showed diffuse and concentric thickening of the aortic walls from the arch to the bifurcation. This suggested an inflammatory process of the aortic wall. After 7 days of treatment with prednisolone, patient was discharged due to decreased pain and no recurrence of other symptoms. Medication was indicated to continue, and a control MRI angiography was requested. Significant pain and imaging improvement was found, so the corticosteroid dose was tapered until it was discontinued. 2024 otro 0120-5552 https://www.redalyc.org/articulo.oa?id=81782334026 https://www.redalyc.org/journal/817/81782334026/ https://www.redalyc.org/journal/817/81782334026/html/ https://www.redalyc.org/journal/817/81782334026/81782334026.epub https://www.redalyc.org/journal/817/81782334026/movil 10.14482/sun.40.03.103.524 en http://www.redalyc.org/revista.oa?id=817 Salud Uninorte application/pdf Universidad del Norte Salud Uninorte (Colombia) Num.3 Vol.40
title	Atypical Presentation of Giant Cell Arteritis: Case Report
topic	Salud vasculitis giant cell arteritis magnetic resonance angiography Computed tomography angiography
url	https://www.redalyc.org/articulo.oa?id=81782334026 https://www.redalyc.org/journal/817/81782334026/ https://www.redalyc.org/journal/817/81782334026/html/ https://www.redalyc.org/journal/817/81782334026/81782334026.epub https://www.redalyc.org/journal/817/81782334026/movil

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