A Tale of Diagnostic Delay with Detrimental Consequences: Illustrating the Challenging Nature of Diagnosing Giant Cell Arteritis

Abstract

Giant cell arteritis is a medical emergency as severe, irreversible complications may occur if it is not treated in a timely manner. However, in daily practice early diagnosis can be challenging. We report the case of a 70-year-old woman who presented with multiple ischaemic cerebral vascular accidents related to newly diagnosed giant cell arteritis. Review of her charts revealed a substantial delay from the onset of symptoms to diagnosis. This case demonstrates the need for additional efforts to reduce delay in referring patients with giant cell arteritis and the need to implement fast-track clinics to prevent serious complications.

Learning points: Giant cell arteritis is a medical emergency and unnecessary diagnostic delay can result in severe complications.Despite implementation of fast-track clinics, diagnostic delay still occurs due to the generic nature of signs and symptoms and inadequate case finding.As diagnostic delay can lead to preventable complications, increased knowledge and awareness of the characteristics and urgency of giant cell arteritis is needed among referring physicians.

Keywords: Giant cell arteritis; diagnostic delay; severe complications.

Figure 1

Longitudinal (A+B) and transversal (C+D) ultrasound images (22 MHz) of the superficial temporal artery. A positive halo sign (A–C) and compression sign (D) were captured. An increased intima-media thickness of 0.61 mm longitudinal (B), and artery compression diameter of 1.5 mm transversal (D) was measured between the measuring points (++)

Figure 2

CT and MRI imaging results supporting the diagnosis. (A) Sagittal plane of the abdominal and chest CT showing a slightly increased aorta vessel wall without an aneurysm. (B) Brain MRI (Ax T1 fs SE 3mm) showing irregular arterial wall enhancement of the left internal carotid artery (large arrows) and both common superficial temporal arteries (small arrows)