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Current Rheumatology Reviews

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ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

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Case Report

Anterior Uveitis with Negative Work-up: Giant Cell Arteritis Remains the Pet Peeve

Author(s): Camille Mercier, Mathilde Scheiber*, Marie-Laure Le Lez, Benoit Erra, Adrien Bigot and Elisabeth Diot

Volume 16, Issue 2, 2020

Page: [165 - 168] Pages: 4

DOI: 10.2174/1573397115666190612142253

Price: $65

Abstract

Background: Giant Cell Arteritis (GCA), is the most common primary vasculitis. It affects large vessels such as the aorta and its branches. According to Chapel Hill Consensus, GCA is one of the larger vessel vasculitis. The underlying mechanism involves inflammation of the large arteries. The most frequent presentation consists of headache, polymyalgia, and jaw claudication. GCA can put the visual prognosis at risk, and rapid diagnosis is compulsory. Cotton wool spots, due to focal inner retinal ischemia, are an early diagnostic ophthalmological sign. The most frequent presentation is a rapid, partial or complete blindness. However, atypical presentations, such as uveitis, especially in the anterior chamber, can delay diagnosis.

Case Report: We report a 75-year-old woman with GCA who initially presented with anterior uveitis and without any other clinical sign. At the beginning, there was the only ophthalmic sign and systemic inflammation, the all exhaustive work-up including positron emission tomography (PET) scan was negative. The biology was fully normal without auto-immune profile (Angiotensin converting enzyme level, Interferon Gamma Release Assay, Syphilis serology, antinuclear antibody titer, Rheumatoid factor, CCP antibodies, and chest x-ray were normal. HLA B27 was negative). In the following weeks, she subsequently developed large vessel vasculitis with headache and more typical sign. She developed cotton wool spots linked to retinal arteriolar hypoperfusion. Anterior uveitis has been reported rarely in GCA and moreover, it is very uncommon at the early stages of GCA. Our case stresses that uveitis onset can precede large vessels vasculitis and typical symptoms of GCA. PET-scan is a useful tool for atypical GCA, but its sensitivity is not perfect, and its repetition can be helpful in selected cases such as that of this patient.

Keywords: Giant cell arteritis, positron emission tomography, c-reactive protein, headache, polymyalgia, syphilis serology.

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[1]
Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013; 65(1): 1-11.
[http://dx.doi.org/10.1002/art.37715] [PMID: 23045170]
[2]
Rai AS, Freund P, Margolin EA, Micieli JA. Numerous Cotton Wool Spots From Giant Cell Arteritis. J Clin Rheumatol 2019.
[http://dx.doi.org/10.1097/RHU.0000000000000995] [PMID: 30664545]
[3]
Liozon E, Ly K-H, Robert P-Y. [Ocular complications of giant cell arteritis]. Rev Med Interne 2013; 34(7): 421-30.
[http://dx.doi.org/10.1016/j.revmed.2013.02.030] [PMID: 23523078]
[4]
Hayreh SS, Podhajsky PA, Zimmerman B. Ocular manifestations of giant cell arteritis. Am J Ophthalmol 1998; 125(4): 509-20.
[http://dx.doi.org/10.1016/S0002-9394(99)80192-5] [PMID: 9559737]
[5]
Védrine L, Algayres JP, Coutant G. Giant-cell arteritis. N Engl J Med 2003; 348(15): 1497-8.
[http://dx.doi.org/10.1056/NEJM200304103481517] [PMID: 12686711]
[6]
Moschos MM, Guex-Crosier Y. Giant cell arteritis: A rare cause of posterior vasculitis. Clin Ophthalmol 2009; 3: 111-5.
[PMID: 19668553]
[7]
Dasgupta B, Pitzalis C, Panayi GS. Inflammation of the uveal tract as a presenting feature of temporal arteritis. Ann Rheum Dis 1989; 48(11): 964-5.
[http://dx.doi.org/10.1136/ard.48.11.964] [PMID: 2596889]
[8]
Slemp SN, Martin SE, Burgett RA, Hattab EM. Giant cell arteritis presenting with uveitis. Ocul Immunol Inflamm 2014; 22(5): 391-3.
[http://dx.doi.org/10.3109/09273948.2013.849351] [PMID: 24143952]
[9]
Rajesh CV, Cole M. Panuveitis as a presenting feature of giant cell arteritis. Br J Ophthalmol 2000; 84(3): 340.
[http://dx.doi.org/10.1136/bjo.84.3.337d] [PMID: 10744385]
[10]
Bandini F, Benedetti L, Ceppa P, et al. Uveitis as a Presenting Sign of Giant Cell Arteritis. J Neuro ophtalmol 2005; 25(3): 247-8.
[11]
Grados A, Sahc P, Cournac JM, et al. L’uveite antérieure bilatérale: une manifestation initiale rare de la maladie de Horton. Rev Med Interne 2012; 335: A117.
[http://dx.doi.org/10.1016/j.revmed.2012.10.187]
[12]
Kluger N, Riviere S, Mura F, Guillot B, Girard C. Simultaneous occurrence of generalized granuloma annulare, anterior uveitis and giant cell arteritis: coincidental or not? Presse Med 2012; 41(5): 548-9.
[http://dx.doi.org/10.1016/j.lpm.2011.08.006] [PMID: 21964039]
[13]
Pipinos II, Hopp R, Edwards WD, Radio SJ. Giant-cell temporal arteritis in a 17-year-old male. J Vasc Surg 2006; 43(5): 1053-5.
[http://dx.doi.org/10.1016/j.jvs.2005.12.043] [PMID: 16678704]
[14]
Dejaco C, Ramiro S, Duftner C, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis 2018; 77(5): 636-43.
[http://dx.doi.org/10.1136/annrheumdis-2017-212649] [PMID: 29358285]
[15]
Besse MC, Collercandy N, Diot E. Gynecologic vasculitis: PET-CT contribution in a rare localization of giant cell arteritis. J Rheumatol 2019; 73(14): 1824-6.
[16]
Duftner C, Dejaco C, Sepriano A, Falzon L, Schmidt WA, Ramiro S. Imaging in diagnosis, outcome prediction and monitoring of large vessel vasculitis: a systematic literature review and meta-analysis informing the EULAR recommendations. RMD Open 2018; 4(1)e000612
[http://dx.doi.org/10.1136/rmdopen-2017-000612] [PMID: 29531788]

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