Online Images in the Medical Sciences| Volume 365, ISSUE 2, e24-e25, February 2023

Pseudo-giant cell arteritis

Published:September 20, 2022DOI:
      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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