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Giant cell arteritis affecting the tongue: a case report and review of the literature SWJ Grant HC Underhill PA Atkin Dental Update 2024 40:8, 707-709.
Authors
SWJGrant
BDS, MFDS, RCS(Eng)
SHO in Oral Medicine, Department of Oral Medicine, University Dental Hospital, Heath Park, Cardiff CF14 4XW, UK
Giant cell arteritis (GCA) is a systemic vasculitis with symptoms that could cause a patient to present to a general dental practitioner. A case of GCA that presented as headache, jaw claudication, unilateral visual loss and tongue ulceration leading to necrosis is reported and the literature reviewed, with an emphasis on dentally relevant aspects. It is vital that GCA is not overlooked in patients over the age of 50 with unexplained dental pain, tissue necrosis or jaw pain which may be misdiagnosed as a temporomandibular joint disorder. Early diagnosis and prompt treatment is the key to preventing visual loss. Early referral in such cases would be warranted.
Clinical Relevance: Dental clinicians may play a part in the early diagnosis of GCA by having a high index of suspicion for its symptoms in patients, so that devastating ischaemic consequences, such as irreversible visual loss, can be prevented.
Article
Giant cell arteritis (GCA) is the most common vasculitis of adults in the western world.1 It is a systemic inflammatory vasculitis that affects medium-to large-sized arteries. Arterial wall inflammation leads to arterial occlusion and tissue ischaemia, which cause the clinical manifestations of vasculitis.2 Early diagnosis and prompt treatment is the key to preventing devastating ischaemic consequences, such as permanent visual loss.3
Some manifestations of GCA may lead to the patient seeking the advice of a dentist. These include unexplained dental pain, oral mucosal necrosis and jaw pain, which may be misdiagnosed as temporomandibular dysfunction (TMJ). Jones and Hazleman4 described three cases that initially presented to the dentist but were not recognized as GCA. Hence, steroid treatment was delayed and the patient remained at risk of blindness.
A case is reported where GCA presented as a headache, jaw pain, necrosis of the tongue and unilateral blindness and the literature relating to GCA is reviewed, particularly in relation to oral and maxillofacial symptoms.
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