An Incidental Finding Of Giant Cell Aortitis (GCA). A Case Report And Review Of The Literature.
Harkins P, Shah Q, Camon A, Wheelan E, O’Rourke K, Mohammad A.
Midlands Regional Hospital Tullamore
GCA is the most common form of systemic vasculitis. Classically it affects the extracranial branches of the carotid arteries however it has the potential for large vessel involvement including the thoracic and abdominal aorta with increased risk of aneurysm and dissection.
We present the case of a 55-year old gentleman with a background of Ulcerative Colitis and associated HLA-B27 positive enteropathic arthritis. He was managed with regimens including adalimumab, methotrexate and prednisolone over a 6 year period since diagnosis.
He presented with a three week history of night sweats, unintentional weight loss and shortness of breath on exertion. His physical examination was unremarkable. He was found to have iron deficiency anemia. He underwent a thorough evaluation to out-rule an underlying neoplastic process. This included colonoscopy which revealed a >1cm polyp in the sigmoid colon for which he underwent polypectomy. Histology revealed an invasive moderately differentiated adenocarcinoma with evidence of lymphovascular invasion and a positive resection margin.
In light of this histology he underwent staging combined PET-CT scanning of the thorax, abdomen and pelvis. This revealed abnormal wall thickening and linear uptake throughout the length of the thoracic and abdominal aorta consistent with aortitis.
Giant cell arteritis was confirmed on subsequent temporal artery biopsy, the histology of which was remarkable for a very high number of giant cells (Despite lack of headache and visual symptoms). Mr X underwent a successful sub-total colectomy for management of his colonic pathology. He was subsequently commenced on Rituximab to manage his GCA, with resolution of symptoms.
This case highlights a less frequent presentation of GCA. In this case the diagnosis was found incidentally during workup for colorectal cancer.
We believe this case highlights that GCA should be considered in the differential for any patient 50 years or older presenting with unexplained fever, anemia or other constitutional symptoms or signs.