Ulcer-like Projection Accompanied by Giant Cell Arteritis.

An 87-year-old man with a 2-month history of a fever was transferred to our department for a further examination. He complained of temporal pain, and contrast-enhanced computed tomography (CT) revealed diffuse wall thickening of the aorta and aortic branches and intimal protrusion of the thoracic aorta, suggesting ulcer-like projection (ULP). Positron emission tomography-CT showed the diffuse accumulation of fluorodeoxyglucose in the aortic wall, including the ULP (Picture). Based on these findings, giant cell arteritis (GCA) was considered, and a temporal artery biopsy confirmed the diagnosis pathologically. Up to 18% of GCA patients are reported to develop an aortic aneurysm and/or dissection, and GCA patients have 17 times the risk of aortic complications as the general population (1). Thus, it is important to diagnose GCA before these critical events. To our knowledge, the relationship between ULP and GCA has not been reported; however, ULP is associated with aortic dissection or rupture (2), and this case shows that ULP can be the initial presentation of GCA.

Picture.

The authors state that they have no Conflict of Interest (COI).