Case of 72-year-old male patient with scalp necrosis, diagnosed as a complication giant-cell arteritis.
A 72-year-old male patient presented with a 1-week history of scalp necrosis. The patient’s medical history was significant for hypertension, dyslipidemia and amputation of the right leg because of acute ischemia.
The painful necrotic ulcerations began as a haemorrhagic patch on the parietal region of the scalp. The ulcerations worsened and spread within 2 days. He complained of a headache, however, without any visual disturbance or polymyalgia rheumatic.
Examination and treatment
On physical examination, extensive necrotic ulcerations and hyperesthesia were notable in both parietal and temporal regions of the scalp. Localised soft tissue hardening was noticeable on the right side, without any pulse. A preliminary diagnosis of scalp necrosis as a complication of giant-cell arteritis was made. Ophthalmic evaluation concluded no signs of abnormalities. Lab results including erythrocyte sedimentation rate were in normal range. However, the patient had an elevated C-reactive protein level, indicating an infection. Temporal artery biopsy showed granulomatous vasculitis of vessel walls with collection of macrophages, neutrophils and giant cells.
Treatment included oral glucocorticoids 1 mg/kg/day. Histopathology confirmed the diagnosis of giant-cell arteritis. No further examinations were required. Although, the oral glucocorticoids and ointment dressings did not help and the lesions worsened. Therefore, the patient was referred to the oral maxillofacial surgery department two weeks later. He was advised several surgical operations. The necrotic ulcerations were excised with trepanning followed by negative pressure wound therapy.
The patient’s postoperative period was uneventful with no progression of necrosis even at 12 months of follow-up. The patient was advised cutaneous grafting, however, he refused as he was satisfied with the outcome. Although there was no relapse of his condition, he died a year later of myocardial infarction.
References
Scalp Necrosis Revealing Severe Giant-Cell Arteritis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443249/
