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Pericardial Involvement as an Atypical Manifestation of Giant Cell Arteritis: Report of a Clinical Case and Literature Review

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ABSTRACT

Purpose

Pericardial effusion has been known to be a rare manifestation of giant cell arteritis. During the last six decades, only 24 cases have been cited in the literature. In this report, we describe the case of a patient presenting with nonspecific symptoms and development of pericardial effusion.

Procedures and Findings

A 71-year-old woman was admitted to the hospital with low-grade fever, exertion breathlessness, atypical diffuse muscular pain, and weight loss over a period of about 5 weeks. Pericardial effusion and giant cell arteritis were diagnosed by echocardiography and left temporal artery biopsy, respectively. Treatment with corticosteroids resulted in remarkable improvement of symptoms and complete remission of pericardial effusion. One year after admission, the patient remained in a stable good condition, under low steroid maintenance dosage.

Conclusions

The diversity of clinical manifestations (such as pericardial effusion) in such a potentially severe disease should alert the physician to prompt diagnosis and treatment in view of impending irreparable vascular damages, even in cases in which the initial presentation is quite uncommon.

Section snippets

Case Report

A 71-year-old woman was admitted in the “Red Cross” General Hospital* with low-grade fever, exertion breathlessness, diffuse muscular pain, and a weight loss of 4 kg developing over a period of about 5 weeks. Headaches, visual disturbances, and jaw and tongue claudication were not reported. Her past medical history was free from any

Discussion

Giant cell arteritis, which is included among vasculitides, is rarely manifested as a systemic panarteritis associated with ischemic symptoms in the extremities, the heart, the central nervous system, the peripheral nervous system, and the abdominal and pelvic viscera.20

Vasculitides have been classified into three groups.21 The first one is related to an immune complex deposition mechanism, the second (where GCA belongs) is characterized by cell-mediated mechanisms along with the formation of

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