Yiling Zhang

Graduated from University of Auckland in 2013. Worked in Waikato DHB and Auckland DHB in house officer and registrar years. Current General Medicine and Rheumatology trainee.

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​Unfortunate Series of Clots

Introduction: ​Giant Cell Arteritis is the most common systemic vasculitis with complications usually resulting from involvement of cranial branch arteries from aortic arch. This severe case study illustrates how widespread the vascular involvement can be.

Case Presentation: Mr. RD is a 58-year-old aircraft engineer who developed ischemic leg post elective left knee joint replacement; failing embolectomy, anticoagulation and thrombolysis treatment, he eventuated to left leg amputation. This was then complicated by bilateral parieto-occiptal infarcts leading to bilateral visual impairment. He was treated with high dose prednisone, underwent rehabilitation and was discharged to home after prolonged admission.

Discussion: Giant Cell Arteritis is usually recognised by persistent headache with scalp tenderness, jaw claudication and visual impairment. However vascular involvement can be widespread. Lower limb involvement and stroke has been reported in case and population studies (Cox B F. J., 2019) (Le Hello C, 2001) (Kuganesan T, 2018) (Samson M, 2015). Classical treatment paradigm includes prolonged courses of high dose glucocorticoids; emerging data for biologics agents provide new opportunities in treatment (Low C, 2019) (Pfeil A, 2019).

References:
Cox B, Fulgham J, Klaas J. 2019. Recurrent Stroke in Giant Cell Arteritis Despite Immunotherapy. Vol. 92 (15 Supplment). Neurology.
Kuganesan T, Huang A. 2018. Stroke as an atypical initial presentation of giant cell arteritis. Vol. 18:55. BMC Geriatr.
Le Hello C, Levesque H, Jeanton M, Cailleux N, Galateau F, Peilon C, Veyssier P, Watelet J, Letellier P, Corutois H, Maiza D. 2001. Lower limb giant cell arteritis and temporal arteritis: followup of 8 cases. Vol. 25 (6). J Rheumatol.
Low C, Conway R. 2019. “Current advances in the traetment of giant cell arteritis: the role of biologics.” Ther Adv Musculoskel Dis 11: 1-11.
Pfeil A, Oelzner P, Hellmann P. 2019. “Treatment of Giant Cell Arteritis in Different Clinical Settings.” Frontiers of Immunology 9 (3129): 1-8.
Samson M, Jacquin A, Audia S, Daubail B, Devilliers H, Petrella T, Martin L etc. 2015. “Stroke associated with giant cell arteritis: a population-based study.” J Neurol Neurosrug Psychiatry 86: 216-221.