Oral and Poster Presentation ARA-NSW 2021 - 43rd Annual NSW Branch Meeting

Spinal cord presentation of biopsy-proven PET-positive giant cell arteritis: a case report (#19)

Grace Swart 1 , Sapna Balgobind 2 , Charles Chan 2 3 , Michael Fulham 4 , Sean Riminton 5 , Emma Mitchell 6 7 , Stephen Reddel 1 3
  1. Neurology, Concord Repatriation Hospital, Sydney, NSW, Australia
  2. Anatomical Pathology, Concord Repatriation Hospital, Sydney, NSW, Australia
  3. Concord Clinical School, University of Sydney, Sydney, NSW, Australia
  4. Functional Medical Imaging, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  5. Immunology, Concord Repatriation Hospital, Sydney, NSW, Australia
  6. Medicine, Port Macquarie Base Hospital, Port Macquarie, NSW, Australia
  7. North Coast Rheumatology, Port Macquarie, NSW, Australia

Objective

We report a case of biopsy-proven and positron emission tomography/computed tomography (PET/CT)-positive giant cell arteritis (GCA) who developed a spinal cord syndrome despite treatment with prednisone.

Methods

A 63-year-old man presented with sudden onset bilateral lower limb weakness and decreased pain and temperature sensation up to his right trunk whilst receiving high dose for biopsy negative GCA, itself having occurred less than two months into treatment of polymyalgia rheumatica. Initial temporal artery biopsy was negative, and he was referred to our centre for further assessment. Examination revealed bilateral lower limb weakness, hyper-reflexia and a right sided sensory level to T8. Magnetic resonance imaging (MRI) whole spine was unremarkable, however somatosensory evoked potentials revealed central conduction delay below the cervical cord.

Results

Active giant cell arteritis with spinal cord involvement was suspected and intravenous methylprednisolone commenced. PET/CT was suggestive of a GCA pattern of vasculitis. Repeat temporal artery biopsy was diagnostic of GCA. The patient was commenced on cyclophosphamide.

Discussion

GCA can rarely present with spinal cord involvement, which is associated with high mortality and therapeutic challenges. False-negative temporal artery biopsies can occur, and PET/CT can be helpful in the evaluation of GCA and supporting its diagnosis.