If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
A 67-year-old woman presented with a 2-month history of headache; jaw claudication, weight loss of 6 kg; right-hand ischemia; and scalp necrosis (Figure 1A and B ), which developed at the same time as her other symptoms. She had no visual symptoms and ophthalmic examination results were normal, with no occult visual arterial abnormalities suggestive of subclinical ischemia. Both temporal arteries were indurated on physical examination. Her C-reactive protein (CRP) level was at 92 mg/L.
Figure 1Scalp necrosis related to giant-cell arteritis.
Duplex ultrasonography showed halo sign (dark halo around arterial lumen) on temporal arteries (Figure 2A) and inflammatory stenosis of right axillary artery (Figure 2B). Moreover, there was aortitis on computed tomography scan.
Figure 2Duplex ultrasonography showed halo sign (dark halo around arterial lumen) on a cross section of temporal artery (A) and inflammatory stenosis on longituinal section of right axillary artery (B).
The patient refused temporal artery biopsy. The diagnosis of scalp necrosis as a complication of giant-cell arteritis (GCA) was made on high clinical suspicion of GCA (age above 50, headache, weight loss, biological inflammatory syndrome, and scalp necrosis) and 2 positive imaging tests; in this context, the diagnosis of GCA may be made without a biopsy.
Prednisone 1 mg/kg per day was started; symptoms improved quickly, with normalization of CRP and a complete healing of the scalp necrosis at 1 month.
The differential diagnoses of scalp ulceration and crusting includes basal cell carcinoma, squamous cell carcinoma, herpes zoster, pustular dermatosis of the scalp, irritant contact dermatitis, pyoderma gangrenosum, and postradiation changes.
Scalp necrosis related to GCA is rare. It is related to occlusive arterial vasculitis, causing tissue ischemia. Lesions respond to systemic corticosteroids, usually at higher doses (prednisone >40 mg/day), and recurrence may occur during steroid taper.
and is usually considered as a poor prognostic indicator in GCA, requiring urgent treatment. Therefore, we believe that tocilizumab, given its recent approval for the treatment of GCA, should be specifically evaluated in this situation.
References
Dejaco C.
Ramiro S.
Duftner C.
et al.
EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice.
31385-9&id=gr1.jpg){kind=link}
31385-9&id=gr2.jpg){kind=link}