Clinical Images: Lingual artery involvement on ultrasonography in giant cell arteritis

Giant cell arteritis (GCA) is a large-vessel vasculitis affecting cranial branches of the external carotid artery,1 typically presenting with headache, scalp tenderness, and jaw claudication. Atypical features such as tongue pain are uncommon.2 The patient, an 84-year-old man with plasma cell dyscrasia and benign prostatic hyperplasia, presented with scalp tenderness, proximal stiffness, jaw claudication, and glossodynia. Markers of inflammation were elevated (erythrocyte sedimentation rate 45.6 mm/h, C-reactive protein 34-45 mg/L). Temporal artery ultrasonography demonstrated abnormal or borderline intima-media thickness in all eight cranial vessels examined (total Halo Score 39 of 48).3 Lingual artery thickening corresponded with the patient's tongue pain (A). High-dose prednisone and acetylsalicylic acid were started, with partial symptom improvement. Methotrexate was subsequently started while glucocorticoids were tapered. Serial ultrasonography over six months showed fluctuating vessel wall changes with resolution of lingual artery thickening (B). Lingual artery vasculitis is an uncommon manifestation of GCA with risk of tongue necrosis if untreated. Ultrasonography allowed noninvasive confirmation of lingual involvement and facilitated longitudinal monitoring of disease activity and treatment response.4 Written informed consent was obtained from the patient for the publication of this case report and accompanying images. Ethics approval was not required due to the nature of the case report. Disclosure form. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.