SHM Converge Scientific Abstract ePoster Gallery-Trismus as the First Manifestation of Giant Cell Arteritis: A Panoramic Clue

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This case report describes a 77-year-old Japanese woman with large-vessel giant cell arteritis (LV-GCA) presenting unusually with trismus as the main symptom. She developed mouth-opening limitation after a facial massage and initially visited a dental clinic, where panoramic radiography showed minimal interincisal separation. She was provisionally diagnosed with temporomandibular joint disorder. Over the next month, her symptoms persisted and were accompanied by low-grade fever, difficulty eating, and a 5 kg weight loss. Although the trismus later improved somewhat, the fever continued, leading to referral to hospital.<br /><br />On examination, she had fever and tachycardia but no typical cranial symptoms of GCA such as headache, jaw claudication, visual disturbance, or temporal artery tenderness. Laboratory tests showed inflammation. Contrast-enhanced CT revealed circumferential wall enhancement of the thoracic aorta, consistent with aortitis. A superficial temporal artery biopsy demonstrated granulomatous inflammation with multinucleated giant cells. She met the 2022 ACR/EULAR classification criteria for LV-GCA.<br /><br />The report emphasizes that trismus is a rare presentation of GCA, reported in only a small proportion of patients, and is usually accompanied by more classic cranial or ocular symptoms. In this case, trismus likely resulted from ischemia of the masticatory muscles due to involvement of distal branches of the external carotid artery. The authors highlight the importance of dentist–physician collaboration and note that panoramic radiography may offer an early clue to GCA in patients with unexplained trismus, helping to ensure timely treatment and prevent ischemic complications.

Asset Subtitle

Yuto Takayama

Meta Tag

Author List Toshio Naito, Yuichi Takahashi, Yuichiro Mine, Yuto Takayama

Category Clinical Vignettes

Concept Trismus

Concept Large-Vessel Giant Cell Arteritis

Concept Giant Cell Arteritis

Concept Masticatory Muscles

Concept Ischemia

Distinguished Non-Finalist

Presenter Organization Clinical Training Center

Presenting Author Yuto Takayama

Track Adult

Keywords

giant cell arteritis

large-vessel vasculitis

trismus

aortitis

temporal artery biopsy

granulomatous inflammation

jaw opening limitation

external carotid artery ischemia

panoramic radiography

dentist physician collaboration

Trismus

Large-Vessel Giant Cell Arteritis

Giant Cell Arteritis

Masticatory Muscles

Ischemia