SHM Converge Scientific Abstract ePoster Gallery-Tongue Twister Leads to Blindness: An Unusual Presentation of Gca

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This case describes a 73-year-old woman with a heavy smoking history and recurrent asthma/COPD who presented with two months of severe oral pain, a large tender ulcerative tongue lesion, weight loss, dysphonia, odynophagia, bilateral otalgia, and mild hearing loss. Initial work-up for infection, autoimmune disease, malignancy, and dental causes was unrevealing. Tongue biopsy showed acute inflammation with bacterial colonization but no dysplasia, carcinoma, vasculitis, or viral/fungal infection. She was treated for candidiasis and her tongue pain improved, but she declined repeat biopsy and was discharged with ENT and rheumatology follow-up.<br /><br />Two months later, she returned with acute left eye blindness, blurred right vision, new left frontal headache, eye pain, and jaw claudication. MRI of the orbits showed bilateral optic nerve abnormalities consistent with optic neuritis. Temporal artery biopsy demonstrated arteritis, supporting a diagnosis of giant cell arteritis (GCA), despite the absence of giant cells on pathology. She was treated urgently with high-dose IV methylprednisolone, then a prednisone taper, and later tocilizumab. Her right-eye vision improved, but left-eye vision loss persisted.<br /><br />The case highlights that GCA can present atypically with tongue ulceration or necrosis due to lingual artery involvement, and that biopsy of the tongue lesion may be nonspecific. Because GCA can lead to irreversible blindness and other serious complications, clinicians should consider it in patients with unexplained tongue ulceration, jaw symptoms, otalgia, constitutional symptoms, or visual complaints, and pursue timely temporal artery biopsy and treatment.

Asset Subtitle

Mary-Nel Saarloos

Meta Tag

Author List Alexandra Lee, Bolanle Mufuka, Dana C. Clifton, Daphne Xiao, Mary-Nel Saarloos, Noppon P. Setji

Category Clinical Vignettes

Concept Giant Cell Arteritis

Concept Irreversible Blindness

Concept Tongue Necrosis

Concept Temporal Artery Biopsy

Concept Early Diagnosis

Distinguished Non-Finalist

Presenter Organization Duke University Hospital

Presenting Author Mary-Nel Saarloos

Track Adult

Keywords

giant cell arteritis

tongue ulceration

optic neuritis

temporal artery biopsy

vision loss

jaw claudication

otalgia

prednisone

tocilizumab

lingual artery involvement

Giant Cell Arteritis

Irreversible Blindness

Tongue Necrosis

Temporal Artery Biopsy

Early Diagnosis