Giant cell arteritis (temporal arteritis): A report of four cases from north east India

Abstract

Giant cell arteritis (GCA) is a common disease of the geriatric age group in the western world, with a prevalence of 0.2% in the fifty plus age group. It is an important cause of morbidity, with irreversible visual loss being the most ominous complication. This diagnosis is an important consideration in all cases of new onset headache in elderly subjects. Reports of giant cell arteritis are few and far between in the Indian subcontinent. In this report, we describe the clinical details of four cases of giant cell arteritis, detected at Guwahati, Assam. The four patients were in the 70-82 age group. Sex distribution was equal. All of them had polymyalgia rheumatica (PMR), with one case displaying an initial presentation as only PMR. Cardinal manifestation was a severe headache, frequently accompanied by scalp allodynia and abnormalities of the superficial temporal artery (STA) on examination. STA biopsy yielded histopathological confirmation in three patients. Permanent visual loss was noted in one patient. These cases highlight the importance of assessing the possibility of giant cell arteritis through appropriate clinical history, estimation of acute phase reactants and the judicious use of superficial temporal artery biopsy, to clinch the diagnosis.

Keywords: Giant cell arteritis; polymyalgia rheumatica.

Figure 1

(A) H and E stained low power sections of the STA of Case 2 showing infiltration with chronic inflammatory cells in the arterial adventitia and the media. Note is made of arterial wall calcification. (B) Hand E stain close up high power view of STA of the same patient showing a focus of intense inflammatory activity with chronic mononuclear cells mainly in the arterial media and in the adventitia. (C) Prominent superficial temporal artery of case 1. This artery was tender to touch