Using temporal artery biopsy to diagnose giant cell arteritis in a patient with bilateral arm ischemia

• Giant cell arteritis is typically associated with jaw claudication, fatigue, weight loss, and laboratory findings including an elevated ESR. It can, however, present with symptoms of limb ischemia.
• Patients with upper extremity involvement of GCA tend to be younger and female. A minority of patients present with only upper extremity ischemia.
• Surgical treatment for ischemic symptoms due to GCA is not well-defined in the literature; here, we describe bypasses with autologous vein and post-operative steroids that led to resolution of the symptoms.

IntroductionBilateral upper extremity ischemia is an unusual presentation of vascular disease. Aetiologies include atherosclerosis as well as rheumatologic diseases. History and physical examination are often, but not always, enough to distinguish between aetiologies and guide treatment.Presentation of caseWe present the case of a female patient with findings neither typical for atherosclerotic or for rheumatologic disease who was ultimately found to have giant cell arteritis affecting her bilateral upper extremities. She underwent bilateral upper extremity bypasses using saphenous vein grafts.DiscussionThis patient presented without symptoms and laboratory findings often seen with GCA, however, biopsy revealed a definitive diagnosis. Treatment options for ischemia secondary to giant cell arteritis are not well-documented in the literature.ConclusionGiant cell arteritis can present in atypical forms, and should remain on the differential when atypical-appearing lesions are found, even in the absence of features usually associated with GCA.