P02 | The Giant’s Causeway: a case report

Background: The Giant Cell Arteritis (GCA) usually involves the cranial arteries, however in some patients a different disease phenotype targets the large vessels with the absence of cranial symptoms.Case report: A 62-year-old woman presented with fever (T max 38°C), myalgia and diffuse abdominal pain. Laboratory studies revealed Hb 11,8 g/dl, serum ferritin 720 mcg/L, an erythrocyte sedimentation rate of 115 mm/h and a C-reactive protein level of 80xULN. The hepatic and renal functions were normal. Blood culture and a cultural panel for gastrointestinal pathogens and stool microscopy for parasites were negative. Abdomen ultrasound revealed no abnormality of the main organs but showed a thickness of aortic wall. Considering the persistence of symptoms and elevation of inflammatory markers, PET/CT scan was performed, which showed increased glucose metabolism of the subclavian arteries (SUV 9), bilateral supra-aortic trunks (SUV 9), thoracic (SUV 7) and abdominal aorta (SUV 9), comparable with large vessels vasculitis. Doppler ultrasonography (CDUS) of both temporal arteries revealed diffuse wall thickening with a “halo sign” >6mm, compatible with diagnosis of giant cell arteritis (GCA). Treatment with high dose methylprednisolone was started, with quick benefit.Conclusions: Temporal artery CDUS is a valid diagnostic support, and it should be performed when the diagnosis is suspected, before or as early as possible after initiation of steroid therapy. Since bilateral ‘halo sign’ is more specific for the diagnosis of GCA, temporal artery biopsy is not mandatory.