An 80-year-old woman first had an itchy scalp and then ulcerating cutaneous lesions of both temples, more pronounced on the right (Figure a). She did not respond to antibiotic and steroid-containing ointments, so a biopsy sample had been taken to exclude malignancy. She also reported unaccustomed jaw pain, which had been treated with the aid of a bite splint. Three months later the patient presented in our hospital with a 2-week history of reduction of right-eye vision to hand movements. She was found to have a pale swelling of the right optic nerve head (Figure b). The initial erythrocyte sedimentation rate was 50 mm (1 h), so after positive duplex sonography of the temporal arteries (extensive echo-poor wall thickening) we diagnosed anterior ischemic optic neuropathy in giant cell arteritis. We immediately started systemic steroid treatment to prevent further vasculitic occlusions of blood vessels. With the help of this treatment the patient’s vision was stabilized and the inflammation subsided. Scalp necrosis and/or jaw pain may be the initial manifestation of temporal arteritis. Giant cell arteritis can be diagnosed at an early stage by physicians of various specialties, preventing progression to blindness.
Figure.
a) Cutaneous necrosis on the right temple caused by vasculitic occlusion of the superficial temporal artery
b) Pale swelling of the right optic nerve head in arteritic anterior ischemic optic neuropathy
Translated from the original German by David Roseveare.
Footnotes
Conflict of interest statement:
The authors declare that no conflict of interest exists.