SHM Converge Scientific Abstract ePoster Gallery-Speak No Evil: Giant Cell Arteritis Presented as Tongue Necrosis

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This case series describes two women with giant cell arteritis (GCA) who presented unusually with tongue pain, ulceration, and necrosis rather than classic symptoms such as jaw claudication, scalp tenderness, or vision loss. Tongue necrosis is a rare ischemic complication of GCA, and it can be mistaken for infection, malignancy, medication effects, or other vascular causes.<br /><br />In Case 1, a 61-year-old woman had repeated visits for mouth and tongue pain before biopsy and inflammatory markers supported GCA. She was treated with IV steroids followed by a prednisone taper and later started on tocilizumab. In Case 2, a 72-year-old woman developed bilateral tongue necrosis and was also diagnosed with GCA by temporal artery biopsy. She received steroids and later tocilizumab as well. Both patients improved and achieved sustained glucocorticoid-free remission.<br /><br />The report emphasizes that prompt recognition is important because tongue necrosis reflects vascular ischemia and may progress rapidly. It also highlights evolving diagnostic criteria: while the 1990 ACR criteria relied heavily on biopsy, the 2022 ACR/EULAR criteria incorporate clinical features, inflammatory markers, imaging, and biopsy results. Ultrasound “halo sign” and other vascular imaging can aid diagnosis.<br /><br />Tocilizumab, an interleukin-6 receptor inhibitor, is supported by clinical trial evidence as a steroid-sparing treatment in GCA. This is especially valuable because long-term glucocorticoid use increases risks such as infection, fractures, diabetes, and hypertension.<br /><br />Overall, the authors stress that GCA should be considered in women over 50 with unexplained tongue pain or ulceration, as early diagnosis and treatment may prevent severe complications.

Asset Subtitle

Antara Dattagupta

Meta Tag

Author List Antara Dattagupta, Colin Diffie

Category Clinical Vignettes

Concept Giant Cell Arteritis

Concept Tongue Necrosis

Concept Tongue Pain

Concept Tongue Ulceration

Concept Temporal Artery Biopsy

Distinguished Non-Finalist

Presenter Organization Washington University in St. Louis

Presenting Author Antara Dattagupta

Track Adult

Keywords

giant cell arteritis

tongue necrosis

tongue pain

ulceration

ischemic complication

temporal artery biopsy

tocilizumab

glucocorticoid therapy

ultrasound halo sign

vascular ischemia

Giant Cell Arteritis

Tongue Necrosis

Tongue Pain

Tongue Ulceration

Temporal Artery Biopsy