Abstract

SA.15.09

Arteriitis temporalis – varying course up to lethal complications

Anne Brüggemann, Maya Müller
Augenklinik, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland

Purpose
Arteriitis temporalis (AT) is a systemic vasculitis and offers a variable course of disease. For further insight, we analyzed our patient data and compared them with the current literature.
Patients and Methods
Retrospective consecutive case series of 66 patients presenting in our clinic in between 2004 and 2008 primarily or for biopsy due to suspect of arteriitis temporalis. Besides ophthalmologic examination, neurologic and internal medical symptoms and complications were followed up. All patients underwent duplex sonography of cranial vessels as well as uni- or bilateral biopsy of the temporal artery. All patients with histologically proven biopsy results were treated with systemic steroid therapy (80-1000mg).
Results
36 patients (54,6%) showed primarily ophthalmological, 21 patients (31,8%) primarily neurologic symptoms, 9 patients (13,6%) primarely medical symptoms. In 32 patients (48,5%) biopsy turned out  histological changes in terms of giant cell arteriitis. Although one patient did not show histological signs of the disease, she was classified as positive because of typical clinical symptoms. Two patients with positive histological findings presented a dramatic course with extensive ischemia of the vertebro-basilaric system:  in one patient with motor and cognitive defects. The other patient suffered from multiple infarction of the brain with lethal outcome. Another patient showed signs of a transient ischemic attack. One patient died because of acute pancreatitis, a rare but drastic side effects of systemic steroid therapy.
Almost half of the patients (48,5%)  with suspect of AT revealed a positive histologic finding. Three of those (9,4%) offered serious to deathly outcomes.
Conclusion
Despite immediate therapy of symptomatic Arteriitis temporalis a noticeable percentage showed a life-threatening course of the disease. Even with interdisciplinary, ameliorated diagnostic and prompt therapy, predictive and progressive factors cannot yet be distinguished. Therefore, arteriitis temporalis should generally be considered as potentially life-threatening.

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