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Grand Rounds at The Johns Hopkins Bayview Medical Center
Clinician's Corner
June 12, 2002

Temporal ArteritisA Cough, Toothache, and Tongue Infarction

Author Affiliations

Author Affiliation: Johns Hopkins University School of Medicine, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Md.

 

Grand Rounds at The Johns Hopkins Medical Institutions Section Editors: David B. Hellmann, MD, D. William Schlott, MD, Stephen D. Sisson, MD, The Johns Hopkins Hospital, Baltimore, Md; David S. Cooper, MD, Contributing Editor, JAMA.

JAMA. 2002;287(22):2996-3000. doi:10.1001/jama.287.22.2996
Abstract

Temporal arteritis, the most common form of systemic vasculitis in adults, is a panarteritis that chiefly involves the extracranial branches of the carotid artery. The condition is illustrated in this article by the case of a 79-year-old woman with a dry cough, toothache, tongue infarction, and vision loss. The mean age of onset is 72 years and the disease rarely occurs in persons younger than 50 years. The most common presenting manifestations are headache, jaw claudication, polymyalgia rheumatica, and visual symptoms. Eighty-nine percent of patients have an erythrocyte sedimentation rate greater than 50 mm/h. However, about 40% of patients present with atypical manifestations, including fever of unknown origin, respiratory tract symptoms (especially dry cough), and large artery involvement. Familiarity with such unusual manifestations of temporal arteritis facilitates early diagnosis and treatment, thereby reducing the risk of vision loss.

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