Clinical History:

A 72-year-old man is bothered by headaches, increasing in frequency and severity over the past month. He has some facial pain on the left. There is photophobia on the left along with decreased vision.

Gross amd Microscopic Pathology:

On physical examination, the temporal artery is prominent and tortuous. Such an artery is palpably thickened and often painful (image 4.1). The microscopic appearance of the lesion at low and high power reveal a granulometous arteritis with giant cells and chronic inflammation, along with narrowing of the vascular lumen (images 4.2 and 4.3).

Questions:

1. What laboratory test would you order?

The erythrocyte sedimentation rate (sed rate) is typically elevated, around 100 mm/hr or greater.

2. What is the diagnosis?

Temporal arterititis. This is also called a giant cell arteritis.

3. How is this condition treated?

Most cases respond to corticosteroid therapy. In fact, this therapy may be all that is needed. Excision of the affected artery can provide symptomatic relief. (There is collateral circulation, so excision of a segment of temporal artery has no vascular consequence). Occasionally, other arteries can be involved, including other external carotid branches, and occasionally the aortic arch and coronaries. Involvement of the ophthalmic branch can lead to blindness.

4. What systemic condition may accompany this lesion?

Polymyalgia rheumatica can occur is some cases of temporal arteritis. This manifests as a flu-like illness followed by joint stiffness.