Tongue necrosis as a rare manifestation of giant cell arteritis in the context of systemic vasculopathy: a case report

ABSTRACT Background Tongue necrosis is rare and usually reflects significant vascular compromise. Giant cell arteritis (GCA) is a medium to large vessel vasculitis with recognised ischaemic complications and is the condition most commonly reported in association with tongue necrosis. We present an unusual case of tongue necrosis in a patient with pre-existing vasospastic and connective tissue disease, illustrating the diagnostic challenge for clinicians. Case Report A 76-year-old woman with Raynaud's phenomenon, scleroderma and carotid stenosis initially presented with pain and paraesthesia of tongue, oral ulceration, oropharyngeal candidiasis and dysphagia. Two weeks later, she re-presented with extensive tongue necrosis. Following rheumatology assessment, a working diagnosis of tongue necrosis secondary to GCA was made. Treatment included high dose corticosteroids and staged surgical debridement. Conclusion This case highlights the importance of considering GCA in patients presenting with lingual ischaemia, particularly where a co-existing systemic vasculopathy may obscure the diagnosis. Oral and maxillofacial surgeons should be alert to early oral signs, with prompt multidisciplinary input and timely corticosteroid therapy essential to limit irreversible tissue loss. Prodromal sensory disturbance and oral ulceration preceding tongue necrosis in the context of vasospastic and connective tissue disease represent a clinically significant and previously unreported presentation.