Mesenteric ischemia in giant cell arteritis: 6 cases and a systematic review.
OBJECTIVE
To report the main features of mesenteric ischemia related to giant cell arteritis (GCA).


METHODS
We screened 13 French internal medicine tertiary care centers for their cases of patients exhibiting GCA-associated mesenteric ischemia during a 16-year period (1990-2006). Patients were included if they reported newly developed abdominal symptoms associated with histological proof of GCA-associated mesenteric vasculitis and/or radiological abnormalities consistent with GCA-associated mesenteric vasculitis. We performed a Medline search to identify previously reported cases of GCA-associated mesenteric ischemia.


RESULTS
We included 6 original cases and 22 cases identified in the literature (mean age of the 28 patients: 72.4 +/- 7.1 yrs; women: 79%). GCA was histologically proven for all patients. In 12 patients GCA diagnosis preceded mesenteric inflammatory arteritis. Mesenteric ischemia occurred either soon after initiation of steroid therapy (n = 6, mean time to onset after starting steroid 12 +/- 11 days) or with a low-dose steroid regimen (n = 6, dosage 0-10 mg/day). In 16 other patients, the mesenteric involvement was the first manifestation of GCA. Only 6 patients (21%) reported cardiovascular risk factors. Clinical manifestations of GCA-associated mesenteric ischemia, as well as biological markers (mean C-reactive protein level 91 +/- 50 mg/l), were very nonspecific. Imaging explorations were performed for 14 patients and showed specific signs of vasculitis on the mesenteric artery in 10 (71%). Nineteen patients (68%) required laparotomy and 9 patients (33%) died.


CONCLUSIONS
Early diagnosis and medical management of mesenteric GCA may ameliorate the severe prognosis of this possibly underdiagnosed complication.
Sujobert
Pierre
P
Department of Internal Medicine, Hôpital Saint-Antoine, Paris, France.
Fardet
Laurence
L
Marie
Isabelle
I
Duhaut
Pierre
P
Cohen
Pascal
P
Grange
Claire
C
Gaultier
Jean-Baptiste
JB
Arrivé
Lionel
L
Cabane
Jean
J
D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications* / Q000378:metabolism; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D011379:Prognosis
D002097:C-Reactive Protein