Beaded prominence of superficial temporal artery

A 71-year-old woman presented to rheumatology clinic with 1month history of temporal headache, obvious prominence of temporal vessel and malaise.Sharp and throbbing headache in the left temporal region has lasted for one month before extending to her right temple about 5 days ago, which was so severe the patient once went to the emergency department to seek immediate relief.She denied symptoms including fever, visual involvement, jaw claudication, arthralgias or myalgias.Physical examination revealed significant beaded enlargement of the left superficial temporal artery with tenderness (Figure 1A).Laboratory testing showed a C-reactive protein level of 101 mg/l (reference range, 0-10) and an erythrocyte sedimentation rate level of 89 mm/h (reference range, 0-20).Duplex ultrasonography revealed a dark halo around the lumen of the temporal artery, indicating diffused thickening of the wall.A diagnosis of giant cell arteritis (GCA) was made.GCA is the most common form of systemic vasculitis in individuals aged 50 years and older.Temporal artery abnormalities including beading, prominence and tenderness are characteristic manifestations of GCA. 1 The patient received high-dose methylprednisolone treatment immediately.After 48 h, patient's symptoms and her temporal artery abnormalities significantly abated (Figure 1B).