Scalp necrosis with giant cell arteritis.
OBJECTIVE
Giant cell arteritis (GCA) often presents with devastating visual loss in the elderly, yet early diagnosis and treatment can prevent visual loss. The authors report two cases of GCA in which scalp necrosis, a rare finding not reported previously in the ophthalmic literature, played an important role in diagnosis.


METHODS
Observational case reports and literature review.


METHODS
Two patients with GCA had scalp necrosis.


METHODS
Intravenous steroid administration was performed.


METHODS
Vision and healing of scalp necrosis were measured.


RESULTS
One patient had scalp necrosis that was diagnosed incorrectly preceding visual loss. Another patient had visual loss in one eye diagnosed as nonarteritic anterior ischemic optic neuropathy. He had scalp necrosis develop 2 weeks later, leading to the correct diagnosis of GCA. There are 21 previously reported cases of scalp necrosis with GCA, none in the ophthalmic literature, most of which were undiagnosed until the onset of visual loss. In addition, a higher rate of visual loss is seen in GCA with scalp necrosis.


CONCLUSIONS
Scalp necrosis is a valuable sign that frequently is misdiagnosed until visual loss occurs. In addition, it may indicate a more severe vasculitis. This finding should be added to the list of signs evaluated in patients for whom GCA is in the differential diagnosis.
Dudenhoefer
E J
EJ
Wilford Hall Medical Center, Department of Ophthalmology, Lackland AFB, Texas, USA.
Cornblath
W T
WT
Schatz
M P
MP
D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009336:Necrosis; D011241:Prednisone / Q000627:therapeutic use; D012535:Scalp / Q000473:pathology*; D012536:Scalp Dermatoses / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D013699:Temporal Arteries / Q000473:pathology*; D014786:Vision Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
D005938:Glucocorticoids; D011241:Prednisone; D008775:Methylprednisolone