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Case Reports
. 2023 May 15;62(10):1541-1545.
doi: 10.2169/internalmedicine.0395-22. Epub 2022 Oct 5.

Giant Cell Arteritis That Presented with Buccal Skin Ulceration along the Facial Artery

Eriko Hasegawa  1 , Yoichi Kurosawa  1 , Ayako Wakamatsu  1 , Hiroe Sato  2 , Daisuke Kobayashi  1 , Takeshi Nakatsue  1 , Takeshi Kuroda  2 , Hiroshi Shimizu  3 , Ichiei Narita  1
Affiliations
Case Reports

Giant Cell Arteritis That Presented with Buccal Skin Ulceration along the Facial Artery

Eriko Hasegawa et al. Intern Med. .

Abstract

A 68-year-old man presented with right buccal ulceration along the facial artery, temporal pain, lagophthalmos, diplopia, and tongue deviation to the right. Contrast-enhanced computed tomography showed bilateral temporal artery and right maxillary artery wall thickening, and a diagnosis of giant cell arteritis (GCA) was made according to the American College of Rheumatology 1990 criteria. Treatment with corticosteroids ameliorated his symptoms. This is the first report of GCA with buccal skin ulceration along a facial artery. Because a delayed diagnosis can lead to irreversible damage, it is essential to notice rare symptoms, such as skin ulceration and multiple cranial neuropathy-like symptoms.

Keywords: buccal skin ulceration; facial artery; giant cell arteritis (GCA); maxillary artery; trismus.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Clinical photograph of the buccal area. A: Buccal ulceration along the course of facial artery at the time of the diagnosis. B: Buccal region three months after starting treatment.
Figure 2.
Figure 2.
Clinical photographs of facial movements. A, D: Maximum opening position of the mouth. B, E: Maximum closing position of the right eye. C, F: The position of the tongue straight out in front. A-C: At the time of the diagnosis. D-F: Three months after starting treatment.
Figure 3.
Figure 3.
Contrast-computed tomography scan of the head. A: Wall thickening was observed in the right temporal artery, and mild wall thickening was observed in the left temporal artery. The lower panel shows a magnified view of the right temporal artery (arrow). B: Wall thickening and narrowing of the lumen were observed in the starting portion of the right maxillary artery. The lower panel shows a magnified view of the right maxillary artery (arrow).
Figure 4.
Figure 4.
Histopathological findings of the right temporal artery. A-D: Shallow temporal artery (*: intima, §: tunica media, ¶: adventitia). There was fibrous thickening of the intima. (A*), with a multilayered internal elastic plate (B*). There is no inflammatory cell infiltration or appearance of multinucleated giant cells in the tunica media (C§). In the tunica adventitia, there are multinucleated neutrophils in the lumen of the vascular vessels (C, arrows) and a few CD3-positive T cells in and around the lumen of the same vessels (D, arrows). The section in D is located in the right half of C. The subcutaneous connective tissue shows ischemic necrosis, with numerous multinucleated neutrophils (E). A, B, Elastica-Goldner staining; C, E, Hematoxylin and Eosin staining; D, CD3 immunostaining. Scale bar = A 100 μm, B 50 μm, C 50 μm, D 50 μm, E 50 μm.
See this image and copyright information in PMC

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