Lingual Necrosis in the Setting of Giant Cell Arteritis

Giant cell arteritis (GCA) is a medium-to-large vessel vasculitis most commonly affecting the aortic arch and carotid branches. Lingual necrosis is a rare complication of GCA caused by lingual artery vasculitis due to ischemia. A delay in diagnosis can result in irreversible complications such as tongue amputation. Our case involves an 83-year-old female patient whose hospital admission for evaluation of stroke-like symptoms was complicated by the development of tongue necrosis, requiring percutaneous endoscopic gastrostomy tube placement for severe odynophagia and dysphagia. The patient was treated with IV glucocorticoids; however, she required tongue amputation due to extensive necrosis as a result of delayed initiation of therapy. Treatment of GCA usually involves an initial high-dose steroid with prolonged steroid taper or immunomodulatory, as relapse is a common occurrence. Prompt diagnosis and appropriate therapy to treat GCA is crucial to prevent the progression of tongue necrosis.