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Tongue Necrosis Secondary to Giant Cell Arteritis: A Case Report and Literature Review

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ABSTRACT

Giant cell arteritis is a form of vasculitis involving the medium- and large-sized arteries that chiefly affects older people. Clinical findings are headache, jaw claudication, fever, pain, and thickening of the temporal artery. The most feared complication is visual loss due to impairment of the ophthalmic artery and posterior ciliary arteries. This a case report of an 85-year-old male presenting with headache and jaw pain, who was admitted with tongue necrosis as an initial manifestation of giant cell arteritis. The necrotic area detached spontaneously after two weeks of therapy with corticosteroids and methotrexate. Reviewing the literature, our patient presented with clinical symptoms consistent with most reports, except for the fact of being male. Although unusual as an initial manifestation, tongue necrosis is an important alert for diagnosing giant cell arteritis. Early diagnosis and treatment of this atypical manifestation may reduce morbidity.

No MeSH data available.


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Clinical appearance of the tongue. (a) Tongue infarction at second day. (b) Initial auto-amputation of necrotic tongue at fifth day. (c) Tongue at 20th day presenting full epithelization.
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fig1: Clinical appearance of the tongue. (a) Tongue infarction at second day. (b) Initial auto-amputation of necrotic tongue at fifth day. (c) Tongue at 20th day presenting full epithelization.

Mentions: On the second day of hospitalization, the patient presented with increased lingual volume associated with intense pain and difficulty in eating. Inspection of the tongue revealed diffuse edema, whitish plaques, and a small aphthous ulcer. Treatment was initiated for oral candidiasis with fluconazole, and later Candida dubliniensis was isolated from a lingual swab. Within 24 hours, the lesion had changed colour, becoming greyish in a bilateral well-defined area, suggesting an ischemic lesion (Figure 1). Temporal pulses were absent and transient bilateral amaurosis appeared, thus confirming the presumptive diagnosis of GCA. Prednisone therapy was initiated with 1 mg/kg/day.


Tongue Necrosis Secondary to Giant Cell Arteritis: A Case Report and Literature Review
Clinical appearance of the tongue. (a) Tongue infarction at second day. (b) Initial auto-amputation of necrotic tongue at fifth day. (c) Tongue at 20th day presenting full epithelization.
© Copyright Policy
Related In: Results  -  Collection

License
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getmorefigures.php?uid=PMC5382308&req=5

fig1: Clinical appearance of the tongue. (a) Tongue infarction at second day. (b) Initial auto-amputation of necrotic tongue at fifth day. (c) Tongue at 20th day presenting full epithelization.
Mentions: On the second day of hospitalization, the patient presented with increased lingual volume associated with intense pain and difficulty in eating. Inspection of the tongue revealed diffuse edema, whitish plaques, and a small aphthous ulcer. Treatment was initiated for oral candidiasis with fluconazole, and later Candida dubliniensis was isolated from a lingual swab. Within 24 hours, the lesion had changed colour, becoming greyish in a bilateral well-defined area, suggesting an ischemic lesion (Figure 1). Temporal pulses were absent and transient bilateral amaurosis appeared, thus confirming the presumptive diagnosis of GCA. Prednisone therapy was initiated with 1 mg/kg/day.

View Article: PubMed Central - PubMed

ABSTRACT

Giant cell arteritis is a form of vasculitis involving the medium- and large-sized arteries that chiefly affects older people. Clinical findings are headache, jaw claudication, fever, pain, and thickening of the temporal artery. The most feared complication is visual loss due to impairment of the ophthalmic artery and posterior ciliary arteries. This a case report of an 85-year-old male presenting with headache and jaw pain, who was admitted with tongue necrosis as an initial manifestation of giant cell arteritis. The necrotic area detached spontaneously after two weeks of therapy with corticosteroids and methotrexate. Reviewing the literature, our patient presented with clinical symptoms consistent with most reports, except for the fact of being male. Although unusual as an initial manifestation, tongue necrosis is an important alert for diagnosing giant cell arteritis. Early diagnosis and treatment of this atypical manifestation may reduce morbidity.

No MeSH data available.


Related in: MedlinePlus