Myocardial infarction and coronary artery involvement in giant cell arteritis.
OBJECTIVE
To describe the pathologic findings in an unusual case of giant cell arteritis that presented initially with visual loss and rapidly culminated in myocardial infarction.


METHODS
After the death of the patient, a complete autopsy was performed, including bilateral enucleation. All specimens, including a temporal artery biopsy completed before the patients death, were processed for routine paraffin histology and initially stained with hematoxylin and eosin. Elastic stains were subsequently used on specimens of temporal and coronary artery. The patient presented with loss of vision in the right eye. The clinical diagnosis was anterior ischemic optic neuropathy, secondary to temporal arteritis. The temporal artery biopsy was positive. Despite high-dose corticosteroid administration, the patient progressed to neurologic impairment, and subsequently to a fatal myocardial infarction.


CONCLUSIONS
Previous reports of temporal arteritis with coronary involvement are summarized. Myocardial infarction may be a more common early complication of temporal arteritis than appreciated previously. This important complication can occur despite administration of high-dose corticosteroid therapy.
Boston University School of Medicine, Department of Ophthalmology, and The New England College of Optometry, Massachusetts 02118, USA.
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Goldstein
D000368:Aged; D001706:Biopsy; D003331:Coronary Vessels / Q000473:pathology*; D017809:Fatal Outcome; D013700:Giant Cell Arteritis / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D018917:Optic Neuropathy, Ischemic / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D013699:Temporal Arteries / Q000473:pathology
D005938:Glucocorticoids