Bilateral Scalp Necrosis: A Rare Manifestation of Giant Cell Arteritis

Excerpt

An 80-year-old woman presented with 3 weeks of fever, chills and bifrontal scalp pain with necrotic skin changes. She had difficulty swallowing and masticatory claudication before the skin changes occurred. Clinical examination revealed necrotic areas in the frontal region spreading to bilateral parietal and temporal regions of the scalp (Figs. 1 and 2). Her erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were 48 mm/hour and 3.61 mg/dl, respectively. Scalp biopsy revealed granulomatous vasculitis involving deeper tissues. Temporal artery biopsy confirmed giant cell arteritis with extensive inflammatory cell infiltration and fragmentation of internal elastic lamina. The patient had marked improvement of skin lesions and resolution of her systemic symptoms with a few months of oral steroid therapy.

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