Giant cell arteritis of the common carotid artery as a differential diagnosis of unilateral neck pain – A case report

 

Introduction Giant Cell Arteritis (GCA) is the most common idiopathic vasculitis in patients 50 years or older in Europe (Gonzalez-Gay et al 2009). Branches of the external carotid artery, especially the superficial temporal artery, are most often involved. GCA usually manifests with cephalgia and visual disturbances, often associated with polymyalgia rheumatica (Jennette et al 2013). Unlike vasculitides such as Granulomatosis with Polyangiitis or Eosinophilic Granulomatosis with Polyangiitis, which affect the mucous membranes of the upper respiratory tract (Coates et al 2020), GCA is diagnosed relatively rarely by ENT physicians.

Methods This is a case report of a 54-year-old patient who was admitted with severe unilateral sore throat with suspicion of a therapy-resistant angina of the salpingopalatine fold. Diagnostic workup included a thorough ENT examination, blood testing of inflammatory parameters, neck ultrasonography, and contrast computed tomography (CT) of the neck.

Results ENT examination was unrevealing. Laboratory studies showed mild leukocytosis and CRP elevation. Ultrasonography revealed an unusually hyperechoic thickened wall of the left common carotid artery, which was confirmed on CT scan, consistent with GCA. Evaluation from the Rheumatology Department confirmed the tentative diagnosis. Treatment with oral glucocorticoids was started with symptomatic improvement.

Discussion The described case underlines the importance of neck ultrasonography as an accessible, dynamic, diagnostic tool without side effects. At the same time, this case highlights that when the very common complaint of sore throat is accompanied by unrevealing examination findings, possible rare diagnoses outside the ENT field should be considered.

Publication History

Article published online:
19 April 2024

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