title: Acute upper limb ischemia, a rare presentation of giant cell arteritis.
abstract: Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10-15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis. We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure. The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers. GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization.
authors.affiliation: Serviço de Cardiologia, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal. Electronic address: lmmorais88@gmail.com.
authors.forename: Luís
authors.initials: L
authors.lastname: Almeida-Morais
authors.affiliation: Unidade Funcional Medicina IV, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Galego
authors.affiliation: Unidade Funcional Medicina IV, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: Nélia
authors.initials: N
authors.lastname: Marques
authors.affiliation: Unidade Funcional Medicina IV, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: Tiago
authors.initials: T
authors.lastname: Pack
authors.affiliation: Serviço de Cirurgia Vascular, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: Hugo
authors.initials: H
authors.lastname: Rodrigues
authors.affiliation: Serviço de Cirurgia Vascular, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Abreu
authors.affiliation: Serviço de Cirurgia Vascular, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: Leonor
authors.initials: L
authors.lastname: Vasconcelos
authors.affiliation: Serviço de Radiologia, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: Hugo
authors.initials: H
authors.lastname: Marques
authors.affiliation: Unidade Funcional Medicina IV, Centro Hospitalar de Lisboa Central, EPE Hospital de Santa Marta, Lisboa, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Sousa Guerreiro
mesh_terms: D000369:Aged, 80 and over; D001011:Aorta; D001132:Arm / Q000098:blood supply*; D005260:Female; D013700:Giant Cell Arteritis / Q000175:diagnosis*; D006801:Humans; D007511:Ischemia / Q000209:etiology*
keywords: Arterite de células gigantes; Bypass carótido-umeral; Carotid-humeral bypass; Critical ischemia; Giant cell arteritis; Isquemia crítica dos membros superiores