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Free Content Giant cell arteritis presenting as facial swelling

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Facial swelling is commonly ascribed to angioedema and a host of other causes. Temporal arteritis (TA), a disease most often diagnosed in patients over the age of 50 years, frequently presents with nonspecific and often ignored complaints (headache, symptoms of polymyalgia rheumatica, low-grade fever, fever of unknown origin, loss of appetite, depression, joint pains, weight loss, hair loss, and even respiratory symptoms). The diagnosis of TA is highly likely in the presence of new-onset headaches, polymyalgia rheumatica, and a tender, cord-like, or swollen temporal artery. Facial swelling must be appreciated as another presentation of TA, especially when accompanied by other nonspecific symptoms. High clinical suspicion, immediate treatment, and definitive diagnosis by temporal artery biopsy are necessary to prevent the most severe vascular complications of blindness and cerebrovascular accidents. Treatment with corticosteroids is most often successful. Because this treatment is fraught with all the risks of high-dose and prolonged steroid therapy, it should only be initiated in cases of significant clinical suspicion, followed by a timely temporal artery biopsy to confirm the diagnosis. Delay in therapy increases the risk of a vascular catastrophe. Delay in obtaining a temporal artery biopsy after therapy has been initiated decreases the diagnostic sensitivity of the test. Other modalities of immunosuppressive therapy remain either unsuccessful or unproven. Concomitant low-dose aspirin therapy appears to hold promise.

Keywords: Blindness; corticosteroid treatment; facial swelling; giant cell arteritis; jaw claudication; ophthalmoplegia; polymyalgia rheumatica; temporal arteritis; temporal artery biopsy

Document Type: Research Article

DOI: http://dx.doi.org/10.2500/aap.2008.29.3161

Affiliations: 1: From the Section of Allergy and Immunology, and 2: Internal Medicine Residency Program, St. Francis Medical Center, Trenton, New Jersey, and Seton Hall University School of Graduate Medical Education, South Orange, New Jersey, 3: Department of Pathology, UMDNJ–Robert Wood Johnson Medical School, RWJ University Hospital Hamilton, Hamilton, New Jersey, 4: Internal Medicine Residency, St. Francis Medical Center, Trenton, New Jersey, and 5: Division of Infectious Diseases, Wyckoff Heights Medical Center, Brooklyn, New York

Publication date: September 1, 2008

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  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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