A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA)
Abstract
:1. Introduction
2. Case Presentation
3. Review
4. Clinical Features
5. Investigations
6. Current Management
7. Discussion
8. Conclusions
9. Patient’s Perspective
“The near daily explanations of my various symptoms by you and your team always proved to be a little mysterious and I have therefore been pleased and grateful to trust your knowledge and integrity and not to worry myself unduly regarding my lack of a physician’s skill. For that reason I am indebted to the entire team for devoting so much of their time and energy into identifying my health problem and to its continuing cure…my stay in hospital remains a blur to me but I shall always be thankful to all who did so much to make me comfortable”.
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Ethics Approval
Consent to Participate
Consent to Publish
Availability of Data and Materials
Abbreviations
GCA | Giant cell arteritis |
TAB | Temporal artery biopsy |
MDT | Multidisciplinary team |
ESR | Erythrocyte sedimentation rate |
VZV | Varicella zoster |
CRP | c-reactive protein |
HLA-DRB | Human leucocyte antigen, nucleotide sequence DRB |
FDG-PET/CT | fluorodeoxyglucose positron emission tomography |
IL- | Interleukin |
FUO | Fever of unknown origin |
Th- | T-helper cell |
ALP | Alkaline phosphatase |
IFN-γ | Interferon gamma |
CK | Creatine Kinase |
MRI | Magnetic resonance imaging |
CT | Computerised tomography |
BSR | British Society for Rheumatology |
ANCA | Anti-neutrophil cytoplasm antibodies |
NICE | National Institutes for Health and Care Excellence |
TNF | Tumour necrosis factor |
DVT | Deep vein thrombosis |
TABUL | The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis: a diagnostic accuracy and cost-effectiveness study |
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Units of Measurement | Normal Range | Patient Values on Admission | Patient Values on Discharge | |
---|---|---|---|---|
Haemoglobin | g/L | 130–170 | 138 | 121 |
White cell count | 109/L | 4.0–11.0 | 26.2 | 11.2 |
Platelets | 109/L | 150–400 | 576 | 308 |
Neutrophil | 109/L | 2.0–7.5 | 21.9 | 7.1 |
Eosinophil | 109/L | 0.0–0.5 | 1.7 | 0.7 |
ESR | mm/h | 1–30 | 22 | 5 |
CRP | mg/L | 0–7.5 | 245 | 33 |
Urea | mmol/L | 2.5–7.8 | 24.2 | 12.4 |
Creatinine | μmol/L | 80–115 | 154 | 130 |
Creatine Kinase (CK) | U/L | 40–320 | 83 | N/A |
ALT | U/L | 10–40 | 30 | 11 |
ALP | U/L | 30–130 | 185 | 88 |
Albumin | g/L | 35–50 | 19 | 25 |
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McCausland, B.; Desai, D.; Havard, D.; Kaur, Y.; Yener, A.; Bradley, E.; Patel, H.P. A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA). Geriatrics 2018, 3, 36. https://doi.org/10.3390/geriatrics3030036
McCausland B, Desai D, Havard D, Kaur Y, Yener A, Bradley E, Patel HP. A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA). Geriatrics. 2018; 3(3):36. https://doi.org/10.3390/geriatrics3030036
Chicago/Turabian StyleMcCausland, Beth, David Desai, David Havard, Yasmin Kaur, Asalet Yener, Emma Bradley, and Harnish P. Patel. 2018. "A Stab in the Dark: A Case Report of an Atypical Presentation of Giant Cell Arteritis (GCA)" Geriatrics 3, no. 3: 36. https://doi.org/10.3390/geriatrics3030036