Ab1285 Acute Brachial Plexitis in Giant Cell Arteritis a Case Report and Systematic Review of the Literature

Background: Acute brachial radiculoplexopathy (BRP) is a neuritis characterized by omalgia, cervicobrachialgia, weakness and atrophy of the brachial muscles. It is usually unilateral, and can be bilateral in up to 25% of cases. It has an incidence of 1.5 cases/100,000 person-years, especially in men and in the 3rd-5th decades of life. Cases of mononeuropathies, mononeuritis multiplex, cervical radiculopathy or PB have been described in the context of giant cell arteritis (GCA)¹. Objectives: In patients with BRP secondary to GCA, our aims were: a) to describe the patient of our center, b) systematic review of the literature. Methods: For systematic review, a search was conducted in Pubmed, Embase, Web Of Knowledge and the Cochrane library. Articles on cases of BRP secondary to GCA were included. Results: Case report: A 69-year-old man with polymyalgia rheumatica in remission complained of cervical pain, temporal headache, weakness and hypoesthesia of the left upper limb. Laboratory studies revealed the increase in C reactive protein (CRP) (10.8 mg/dl) and in erythrocyte sedimentation rate (ESR) (58 mm/hour). The electroneurophysiological study confirmed involvement of the left C5 and C6 roots. In PET, increased vascular activity was observed (image). The biopsy of the left temporal artery concluded GCA. The treatment with glucocorticoids (GC) achieved complete neurological recovery. Systematic review: In the literature (with our case), we have found 28 observations of BRP due to GCA, with a global distribution. Among all these cases, there were 14 women and 14 men, and the average age was 69,5 years (range: 53 to 85), which is consistent with the usual epidemiological data of GCA. Inflammatory markers were searched for in 26 patients: The ESR was ≥ 50mm/h in 75% of the patients, reaching ≥ 100 mm/h in 35.7% of the cases. CRP was elevated in 100% of the patients. 17 patients (60,7%) complained of headache, 15 (53,6%) complained of cervicalgia and only 11 (39,3%) complained of shoulder pain. Constitutional syndrome and fever were observed in 11 (39,3%) and 9 (32,1%) patients, respectively. Scalp tenderness and jaw claudication were very infrequent with 5 (17,9%) and 6 (21,4%) patients, respectively. 5 patients (17,9%) presented another concomitant neurological symptom (cranial nerve involvement was the most frequent). BRP was bilateral in 16 patients (57,1%), mostly affecting C5 (100%) and C6 (85,7%). The less affected roots were C4 (14,3%) and C7 (25%). The main complementary tests performed as well as the treatments/evolution of the patients are summarized in the following Tables 1 and 2: Conclusion: Brachial plexopathy is a rare initial presentation of GCA, but we should consider it in elderly patients with neurological involvement². In our sample, BRP affects men and women equally. Most of the patients had involvement of the C5-C6 roots bilaterally. C4 involvement was rare and it was fatal in 1 case. Up to 18% of patients associated another type of neurological condition, the most common was cranial nerve involvement, while only one case suffered from AION. In addition to headache, patients with BRP may present neck pain and omalgia. RFAs are increased in most cases. Both vascular ultrasound and PET/TC revealed alterations compatible with GCA in the majority of patients.Temporal biopsy, at least in our review, appears to have greater diagnostic capacity than usual. Unlike what happens with AION, BRP usually responds completely to GC in monotherapy, although treatment should be instituted as soon as possible to avoid permanent deficits. REFERENCES: [1] Briceño PF,et al.2010;11(4):144-151. [2] Duval F et al.2018;23(1):23-28. Acknowledgements: NIL. Disclosure of Interests: None declared.