Background and Aims
Anxiety disorders, migraine, and vasculitides, such as Giant Cell Arteritis (GCA), may occur following several viral infections, including SARS-COV-2 and they present an emerging challenge for clinical neurologists in the current COVID-19 pandemic. Its mechanisms include endothelial cell inflammation, apoptosis and dysfunction. We report a case of chronic headache due to GCA accompanied by anxiety disorder and probable inflammatory bowel disease following COVID-19 infection. The aim is to report a case of a daily chronic headache due to GCA accompanied by anxiety disorder following COVID-19 infection.
Methods
A 44-year-old Hispanic female who denied previous history of COVID-19 presented with persistent, intense, dull-oppressive, occipital-temporal, crown-like irradiation headache accompanied by mouth-face weakness, and amaurosis-like visual disturbances. Other symptoms included anxiety attacks, insomnia, stress and hearing discomfort. Anxious behavior and mood changes persisted with oppressive chest pain, nausea and vomiting. Physical examination showed tachycardia, jaw claudication, pain in occipital and right temporal region and at the temporal artery, tinnitus, bilateral cervical trigger points, positive Marinescu and Romberg’s. Bloodwork showed negative ESR and CRP, positive ANA 1/160 and elevated calprotectin. SARS-CoV-2 IgM was positive. Doppler ultrasound of the right temporal artery showed a positive halo sign, thus giant cell arteritis diagnosis was established, and regular treatment was initiated.
Results
The patient underwent partial resolution of the symptoms after receiving corticosteroids, paroxetine, propanol, topiramate, and a gluten-free diet.
Conclusions
Autoimmune diseases, like giant cell arteritis, could appear in patients with an unknown or asymptomatic history of COVID-19. SARS-COV2 infection should be considered as a trigger of postinfectious vasculitides.