GIANT-CELL ARTERITIS INVOLVING THE LOWER-LIMBS

We report the case of a 62-year old woman hospitalized for acute ischa emia of the right lower limb, caused by stenosis of the superficial fe moral artery associated with thrombosis of the deep femoral artery. Th rombo-endarteriectomy was performed, and histology of the operative sp ecimen showed thickening of the media with clusters of giant cells and fragmentation of the internal elastic lamina, without atheroma. The d iagnostic of giant cell arteritis was then considered and confirmed by the presence of headaches, 38-degrees-C fever and inflammatory syndro me with ESR at 75 mm in the first hour. On the other hand, biopsy of a temporal artery was negative. Corticosteroid therapy was prescribed a nd gave excellent clinical, laboratory and arteriographic results. It has now been demonstrated that the arteries of the lower limbs may be involved in Horton's giant cell arteritis, which is often overlooked. This involvement is rare and exceptionally proven at histology. Clinic ally, the most frequently described form is one of pseudo-arteritis wi th claudication, but a few cases of gangrene have been reported. Withd rawal of corticosteroid might be a facilitating factor. As in our pati ent, the arteriographic lesions are often segmental, multifocal and sy mmetrical, predominant in the superficial femoral artery and the arter ies of the legs. The lesions regress under corticosteroid therapy, and surgery can usually be avoided. Anticoagulants are commonly prescribe d when the large vessels are involved. When surgery is not indicated t he diagnosis can be confirmed by biopsy of the temporal artery, which is positive in the majority of cases.