[Respiratory manifestations of giant cell arteritis: 8 cases and review of the literature]

Abstract

Background: Pleural and pulmonary manifestations of giant cell arteritis are rare and not well known. They can be associated to more typical signs of the disease and to an inflammatory biological syndrome which are comprised in the multisystemic manifestations of the disease. They can be inaugural, leading to a late management if unrecognized.

Methods: Retrospective and descriptive study of 8 cases over a 10 year period was conducted. Five females and three males with a 67-year-old average age were included according to the American College of Rheumatology criteria. They illustrated the clinical and/or radiological respiratory manifestations of the disease.

Results: Pulmonary manifestation was inaugural in six cases over eight. The time to diagnosis range was 15-60 days. Cough was the most frequent symptom (five cases over eight). Dyspnea with orthopnea was described in one case. Pleural and parenchymal radiological manifestations had no specific characteristics: pleurisy, pleural thickening, nodules of variable size, reticular lesions. Temporal artery biopsy was positive in five cases, atypical in one case and negative in two cases. Bronchial and transbronchial biopsies (in two and one cases respectively) did not find any specific lesion. Clinical and radiological signs disappeared quickly after the introduction of glucocorticoid therapy.

Conclusion: The knowledge of these different respiratory manifestations during giant cell arteritis (persistent cough, nodules, pleural effusion) is useful for the clinician. It helps him in prescribing non invasive investigations or even a presumptive glucocorticoid therapy, in an often old and weakened patient.