Large-vessel giant cell arteritis eleven months after a diagnosis of erythema nodosum

Abstract

Giant cell arteritis (GCA) is a type of vasculitis that occurs among the elderly and is categorised as granulomatous vasculitis of large- and medium-sized vessels. We herein report a case of GCA in a 78-year-old woman with an 11-month history of erythema nodosum (EN). She presented with fever, chest pain and headache. Inflammatory markers, including C-reactive protein and the erythrocyte sedimentation rate, were elevated. Computed tomography (CT) revealed thickening of the arterial walls from the aortic arch. Positron emission tomography/CT showed uptake of ¹⁸F-fluorodeoxyglucose in the walls of the proximal left common carotid and left subclavian arteries. The presence of temporal arteritis could not be confirmed. We diagnosed the patient with large-vessel GCA (LV-GCA). Induction therapy with prednisolone resulted in the rapid amelioration of her symptoms and inflammation. Cutaneous manifestations other than scalp necrosis in GCA are uncommon. In this case, EN preceded the onset of LV-GCA. The present case suggests EN can be a clinical manifestation of LV-GCA.

Keywords:

• Giant cell arteritis
• erythema nodosum
• skin lesion
• systemic inflammatory responses

Acknowledgements

We are especially grateful to Dr. Takamitsu Jono and Dr. Koji Makino in the department of dermatology for examination and treatment of the erythema nodosum and Dr. Toshihiko Murayama in the department of diagnostic pathology for the diagnosis of erythema nodosum at the National Hospital Organisation Kumamoto Medical Centre.

Patient consent

Written informed consent was obtained from the patient for publication of this case report.

Ethical Approval

Not Applicable.

Conflict of interest

None.