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Case report
Giant cell arteritis complicated by tongue necrosis and bilateral cerebellar ischaemic stroke
  1. Emily Charlotte Rose1,
  2. Liam Stuart Carroll2,
  3. Sue Evans3 and
  4. Alice Mason1
  1. 1Department of Rheumatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  2. 2Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  3. 3Department of Stroke Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Liam Stuart Carroll; liam.carroll{at}uhs.nhs.uk

Abstract

Giant cell arteritis (GCA) typically presents with headache, scalp tenderness or visual disturbance. Other symptoms include orofacial pain, constitutional symptoms and ischaemic stroke. An 81-year-old woman with a background of type-2 diabetes and hypertension presented with headache, oral pain and right visual loss. Examination showed hypertension, nodular temporal arteries, reduced visual acuity and suspected oral candida. Inflammatory markers were raised and she was diagnosed with GCA and commenced on corticosteroids. During treatment she developed tongue ulceration, then acute vertigo and incoordination with nystagmus and ataxia. Neuroimaging confirmed bilateral, cerebellar ischaemic strokes and temporal artery biopsy was consistent with GCA. With corticosteroids and secondary prevention of stroke measures she is now functionally independent. Oral pain is an uncommon symptom of GCA and delays in recognition may lead to catastrophic consequences. Clinicians should be aware of uncommon presentations and to optimise additional ischaemic stroke risk-factors.

  • stroke
  • vasculitis
  • pain (neurology)

http://dx.doi.org/10.1136/bcr-2021-244948

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    Footnotes

    • Contributors ECR provided care for the patient, gained consent for publication and drafted and revised the manuscript. LSC cared for the patient and assisted with manuscript draft and revision. SE cared for the patient and contributed to manuscript revision. AM cared for the patient and contributed to manuscript revision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.