DÄ internationalArchive42/2021Scalp Necrosis and Jaw Pain as Cardinal Symptoms

Clinical Snapshot

Scalp Necrosis and Jaw Pain as Cardinal Symptoms

Dtsch Arztebl Int 2021; 118: 719. DOI: 10.3238/arztebl.m2021.0085

Biermann, J; Brücher, V C

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a) Cutaneous necrosis on the right temple caused by vasculitic occlusion of the superficial temporal artery; b) Pale swelling of the right optic nerve head in arteritic anterior ischemic optic neuropathy
Figure
a) Cutaneous necrosis on the right temple caused by vasculitic occlusion of the superficial temporal artery; b) Pale swelling of the right optic nerve head in arteritic anterior ischemic optic neuropathy

An 80-year-old woman first had an itchy scalp and then ulcerating cutaneous lesions of both temples, more pronounced on the right (Figure a). She did not respond to antibiotic and steroid-containing ointments, so a biopsy sample had been taken to exclude malignancy. She also reported unaccustomed jaw pain, which had been treated with the aid of a bite splint. Three months later the patient presented in our hospital with a 2-week history of reduction of right-eye vision to hand movements. She was found to have a pale swelling of the right optic nerve head (Figure b). The initial erythrocyte sedimentation rate was 50 mm (1 h), so after positive duplex sonography of the temporal arteries (extensive echo-poor wall thickening) we diagnosed anterior ischemic optic neuropathy in giant cell arteritis. We immediately started systemic steroid treatment to prevent further vasculitic occlusions of blood vessels. With the help of this treatment the patient’s vision was stabilized and the inflammation subsided. Scalp necrosis and/or jaw pain may be the initial manifestation of temporal arteritis. Giant cell arteritis can be diagnosed at an early stage by physicians of various specialties, preventing progression to blindness.

Prof. Dr. med. Julia Biermann, Dr. med. Viktoria C. Brücher, Ambulanz für Orthoptik, Neuro- und Kinderophthalmologie, Orbitaerkrankungen
Klinik für Augenheilkunde, Universitätsklinikum Münster, julia.biermann@ukmuenster.de

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Biermann J, Brücher VC: Scalp necrosis and jaw pain as cardinal symptoms. Dtsch Arztebl Int 2021; 118: 719. DOI: 10.3238/arztebl.m2021.0085

a) Cutaneous necrosis on the right temple caused by vasculitic occlusion of the superficial temporal artery; b) Pale swelling of the right optic nerve head in arteritic anterior ischemic optic neuropathy
Figure
a) Cutaneous necrosis on the right temple caused by vasculitic occlusion of the superficial temporal artery; b) Pale swelling of the right optic nerve head in arteritic anterior ischemic optic neuropathy