An 84-year-old man was admitted with 30-day history of fever with jaw claudication
and diplopia. Physical examination did not reveal any abnormalities in the temporal
artery. The erythrocyte sedimentation rate was 65 mm/h and the serum creatinine level
was 1.23 mg/dl. Urinalysis revealed 1+ protein and 30–49 erythrocytes/high power field.
Three sets of blood culture were negative. On admission day 5, we performed a temporal
artery biopsy, suspecting giant cell arteritis from jaw claudication and diplopia.
On day 7, dysmorphic red blood cells were found in the urine. Myeloperoxidase anti-neutrophil
cytoplasm antibodies (MPO-ANCA) were 122 U/ml, and the serum creatinine level worsened
to 1.56 mg/dl. Suspecting ANCA-associated vasculitis, we performed a renal biopsy
and glucocorticoid pulse therapy. The temporal artery biopsy revealed a normal temporal
artery (asterisk) (Fig. 1A) and vasculitis of the small vessels (arrows) (Fig. 1B) around the temporal artery. A renal biopsy showed crescentic glomerulonephritis
(Fig. 2). There was no granuloma in the lung and nasal cavity in computed tomography. Based
on the findings, we diagnosed microscopic polyangiitis. After glucocorticoid therapy,
the patient's symptoms and serum creatinine level improved.
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References
- Does this patient have temporal arteritis?.JAMA. 2002; 287: 92-101
- The use of clinical characteristics to predict the results of temporal artery biopsy among patients with suspected giant cell arteritis.J Rheumatol. 1995; 22: 93-96
- Temporal arteritis associated with systemic necrotizing vasculitis.J Rheumatol. 2003; 30: 2165-2169
Article info
Publication history
Published online: September 20, 2022
Accepted:
September 12,
2022
Received:
November 2,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
