Temporal arteritis associated with systemic necrotizing vasculitis.
OBJECTIVE
To evaluate the clinical and laboratory characteristics of patients with systemic vasculitis associated with temporal artery involvement.


METHODS
From a cohort of 120 patients fulfilling American College of Rheumatology criteria for temporal arteritis, we retrospectively identified 7 patients with systemic necrotizing vasculitis associated with histological temporal arteritis.


RESULTS
Among the 7 patients, 2 had classic polyarteritis nodosa, one had unclassified systemic vasculitis, one had Wegener's granulomatosis (WG), and 3 had microscopic polyangiitis. The mean age of the patients was 70.2 years, and cranial symptoms revealed the disease in all but one patient. Temporal arteritis was generally associated with extracephalic manifestations suggestive of systemic vasculitis. Antineutrophilic cytoplasmic antibodies were positive in 3 of the 4 patients with small vessel vasculitis. Pathologically, the main temporal artery was involved in all but one patient, with inflammatory infiltrate of vasa vasorum and adventitia associated in 5 with small tributary involvement. Fibrinoid necrosis was rare, observed in 2 specimens; 2 patients with unclassified systemic vasculitis and WG had a classic giant cell arteritis (GCA) histologic pattern. Only one patient had exclusive involvement of small vessels, surrounding the spared main temporal artery. Muscle biopsies showed histopathological evidence of vasculitis in 2 patients, skin biopsy in one, and vein biopsy in the other.


CONCLUSIONS
Temporal artery involvement in systemic necrotizing vasculitis was generally associated with extracranial clinical features suggestive of systemic vasculitis. Temporal artery biopsy is a simple tool for diagnosis of vasculitis, but the histopathological findings do not always discriminate between necrotizing vasculitis and classic GCA.
Hamidou
Mohamed A
MA
Department of Internal Medicine and Laboratory of Pathology, University Hospital Hôtel-Dieu, Place Alexis Ricordeau, Nantes 44035, France. mohamed.hamidou@chu-nantes.fr
Moreau
Anne
A
Toquet
Claire
C
El Kouri
Dominique
D
de Faucal
Philippe
P
Grolleau
Jean-Yves
JY
D000368:Aged; D015331:Cohort Studies; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications* / Q000473:pathology; D014890:Granulomatosis with Polyangiitis / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010488:Polyarteritis Nodosa / Q000150:complications* / Q000473:pathology; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000473:pathology