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Case Report
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| Giant cell arteritis presenting as tongue necrosis | ||||||
| Ritesh Kohli1, Eleni Tiniakou2, Joao M Nascimento3, Gbonjubola Oyefeso1 | ||||||
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1MD, Resident, Internal Medicine, Bridgeport Hospital, Yale University Hospital, Bridgeport, CT, USA.
2MD, Chief Resident, Internal Medicine, Bridgeport Hospital, Yale University Hospital, Bridgeport, CT, USA. 3MD, Rheumatologist, Bridgeport Hospital, Yale University Hospital, Bridgeport, CT, USA. | ||||||
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| How to cite this article: |
| Kohli R, Tiniakou E, Nascimento JM, Oyefeso. Giant cell arteritis presenting as tongue necrosis. International Journal of Case Reports and Images 2013;4(11):638–640. |
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Abstract
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Introduction:
Giant cell arteritis (GCA) is a large and medium-vessel systemic vasculitis affecting predominantly the internal and external carotid arteries with particular affinity for its extra-cranial branches (especially, the superficial temporal artery). The most frequent complication of this disorder is visual loss. We report the case of a patient who suffered tongue necrosis (a rare complication) secondary to giant cell arteritis.
Case Report: A 71-year-old female who after having her dentures refitted developed severe pain, edema of the tongue, odynophagia, dysphagia and resultant anorexia. She was admitted with the diagnosis of glossitis and initially treated with antifungals and later antiviral medications without improvement. She subsequently developed tongue ulcerations, severe pain in temporomandibular joint (TMJ) with right sided headache. Temporal arteritis was suspected at this point, re-examination revealed palpable and tender temporal arteries (R>L). Tongue examination demonstrated dark greyish plaques in the dorsum with areas of ulceration without palatal involvement. An elevated ESR and the right sided temporal artery biopsy that followed demonstrating chronic inflammation with the presence of giant cells confirmed the diagnosis of GCA. Treatment with oral prednisone (1 mg/kg/day) produced a rapid improvement of her symptoms and ulcers with complete resolution at three months. Conclusion: The presence of glossitis in GCA represents a severity marker of this disease and is associated with a higher risk of vision loss and mortality. As such a high level of suspicion is necessary for the early recognition of this rare presentation and prompt institution of treatment to prevent the aforementioned complications. | |
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Keywords:
Giant cell arteritis (GCA), Scalp necrosis, Temporal artery biopsy
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Author Contributions
Ritesh Kohli – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Eleni Tiniakou – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Joao M Nascimento – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published Gbonjubola Oyefeso – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© Ritesh Kohli et al. 2013; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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