title: Using temporal artery biopsy to diagnose giant cell arteritis in a patient with bilateral arm ischemia.
abstract: BACKGROUND
  Bilateral upper extremity ischemia is an unusual presentation of vascular disease. Aetiologies include atherosclerosis as well as rheumatologic diseases. History and physical examination are often, but not always, enough to distinguish between aetiologies and guide treatment.
  
  
  METHODS
  We present the case of a female patient with findings neither typical for atherosclerotic or for rheumatologic disease who was ultimately found to have giant cell arteritis affecting her bilateral upper extremities. She underwent bilateral upper extremity bypasses using saphenous vein grafts.
  
  
  CONCLUSIONS
  This patient presented without symptoms and laboratory findings often seen with GCA, however, biopsy revealed a definitive diagnosis. Treatment options for ischemia secondary to giant cell arteritis are not well-documented in the literature.
  
  
  CONCLUSIONS
  Giant cell arteritis can present in atypical forms, and should remain on the differential when atypical-appearing lesions are found, even in the absence of features usually associated with GCA.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: Julia.Glaser@uphs.upenn.edu.
authors.forename: Julia
authors.initials: J
authors.lastname: Glaser
authors.affiliation: Division of Rheumatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sharim
authors.affiliation: Division of Rheumatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Belinda
authors.initials: B
authors.lastname: Birnbaum
authors.affiliation: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Montone
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: Wang
keywords: Claudication; Giant cell arteritis; Upper extremity ischemia