e08 A case of large saddle pulmonary embolism in a patient with giant cell arteritis

Abstract

Background: Giant cell arteritis (GCA) is a large vessel arteritis with a predilection for inflammation of the cranial vessels, most typically presenting with new onset headaches, scalp tenderness and elevated inflammatory markers. Severe GCA may be associated with intracranial arteritis, causing strokes and anterior ischaemic optic neuropathy. Concurrent inflammation of other large vessels (coronaries, subclavian arteries etc.) from the aortic arch is not unusual. Since 1991, seven cases of concurrent pulmonary embolism (PE) and GCA have been reported with 1 case having post mortem histological confirmation in the pulmonary arteries and 1 case demonstrating PET/CT evidence in both aorta and pulmonary artery. Two of the seven case reports informed of deaths due to pulmonary embolism, including the case with histological confirmation in pulmonary vessels. We report of a 69 year old female who presented with a new onset headache and jaw claudication classical of giant cell arteritis with good clinical and biochemical response to high dose prednisolone, although her temporal artery was non-diagnostic for GCA. She also presented with dyspnea at the onset of her headache, which continued to progress over the months during the treatment of her GCA. She was eventually found to have large saddle PE on CT scan and started on anti-coagulation. Although she is found to be a heterozygote carrier for factor II prothrombin G20210a mutation, the risk for thromboembolic event in a heterozygote carrier state is controversial. The onset of an inflammatory vasculitis could have been the triggering event that exacerbates her thrombophilic state in the background of factor II G20210a mutation. It is rare for both disorders to develop simultaneously, but it is important to pay close attention to pervasive symptoms of dyspnea in a patient with GCA, rather than to surmise it as a non-specific symptom of GCA or steroid toxicity, particularly since severe PE carries significant mortality. Methods: Please refer to background. Results: Please refer to background. Conclusion: Please refer to background.