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September 1990

Scalp Ulcerations in an Elderly Woman

Author Affiliations

Toronto (Ontario) Western Hospital, University of Toronto

Arch Dermatol. 1990;126(9):1225-1226. doi:10.1001/archderm.1990.01670330105018

REPORT OF A CASE  An 86-year-old woman, who resided in a nursing home, complained of headache and tenderness in the right temporal region. Two weeks later, she suffered visual loss in the right eye. Following an ophthalmological examination, she underwent nuclear and computed tomographic brain scans. The diagnosis was acute glaucoma. During these investigations, tender crusted lesions developed on the scalp (Fig 1). She was then referred to a dermatologist, who arranged for her admission to the hospital.Laboratory studies disclosed the following values: hemoglobin, 10.4 g/L; and erythrocyte sedimentation rate, 76 mm/h. A diagnostic biopsy was performed (Figs 2 and 3).What is your diagnosis?

DIAGNOSIS:  Temporal arteritis.HISTOPATHOLOGICAL FINDINGS AND CLINICAL COURSEThe biopsy specimen of the temporal artery revealed a narrowed lumen with subintimal proliferation. Inflammatory cells in the media consisted of lymphocytes, plasma cells, and histiocytes. The elastic stain showed fragmentation of the internal elastic lamina with giant cells in close proximity (Fig 4).

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