Bitemporal Scalp, Lip and Tongue Necrosis in Giant Cell Arteritis: A Rare Presentation
A 74-year-old man was presented with high-grade fever, sudden onset bilateral temporoparietal headache, jaw claudication, and diminished vision in both eyes for last 7 days. On examination, he had bilateral scalp, lip, and tongue necrosis [Figures and ]. On clinical examination, the temporal arteries were palpable tender and nonpulsatile. In addition, he had exposure keratopathy and diminished corneal reflexes.\nRoutine hematological and biochemical investigations revealed raised erythrocyte sedimentation rate (ESR: 132 mm at the end of 1 h), anemia (hemoglobin: 8.6 g/dl), leukocytosis (total leukocyte count: 19,700/mm3), thrombocytosis (platelet count: 9, 94,000/mm3), and raised C-reactive protein level (10 mg/L). ANA was negative and the bone marrow examination was normal. The temporal artery biopsy was compatible with giant cell arteritis and showed infiltration of media tunica by lymphocytes and giant cells []. There was a focal destruction of internal elastic lamina and narrowing of the lumen due to fibrin deposition. Ultrasonography and color Doppler was not performed as the patient was bedridden, and we felt it was unnecessary at that given point of time.\nWe have treated this patient with systemic corticosteroids (oral prednisolone: 1 mg/kg body weight per day). After an initial improvement in headache and scalp necrosis (within 24-36 h of initiation of therapy), there was no improvement for another 2-3 days, neither it was deteriorating. The patient's relatives decided to take him home against the medical advice. Therefore, further follow-up could not be possible.