Abstract

CONTRERAS ACOSTA, RAFAEL et al. Atypical Presentation of Giant Cell Arteritis: Case Report. Salud, Barranquilla [online]. 2024, vol.40, n.3, pp.1126-1137.  Epub May 26, 2025. ISSN 0120-5552.  https://doi.org/10.14482/sun.40.03.103.524.

Giant cell arteritis (GCA) is a granulomatous vasculitis of medium and large arteries that usually affects the aorta and/or its main branches. We report a 66-year-old, female, black, and an active smoker patient. The patient consulted due to diffuse abdominal pain, nausea, vomiting, without neurological manifestations suggestive of intracranial involvement. Vital signs within acceptable limits, pain on palpation in the epigastrium and left flank, and positive renal fist percussion. Computed tomography (CT) angiography showed intramural inflammatory lesions and Stanford type B aortic dissection; therefore, transfer to the intensive care unit was indicated. Vascular surgery suggested intramural hematoma of the descending aorta and ulcer adjacent to the minor celiac trunk. Oral beta-blocker was started. Markers and an electrocardiogram were taken without findings of acute coronary cause. Control CT angiography showed thickening of the aortic walls from the arch to the bifurcation consistent with aortitis with elevated acute phase reactants. Pain improved and the patient was transferred to the general ward. Control images indicated suspicion of GCA vasculitis, so management with corticosteroids was started. Patient reported pain again, and a magnetic resonance (MRI) angiography was requested. It showed diffuse and concentric thickening of the aortic walls from the arch to the bifurcation. This suggested an inflammatory process of the aortic wall. After 7 days of treatment with prednisolone, patient was discharged due to decreased pain and no recurrence of other symptoms. Medication was indicated to continue, and a control MRI angiography was requested. Significant pain and imaging improvement was found, so the corticosteroid dose was tapered until it was discontinued.

Keywords : Aortitis; computed tomography angiography; giant cell arteritis; magnetic resonance angiography; vasculitis.

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