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.
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.
Hellmann DB. Temporal ArteritisA Cough, Toothache, and Tongue Infarction. JAMA. 2002;287(22):2996-3000. doi:10.1001/jama.287.22.2996