Scalp necrosis in giant cell arteritis

Giant cell arteritis (GCA) is a systemic granulomatous vasculitis of large and medium vessels most commonly affecting the branches of the external carotid artery, mainly the superficial temporal artery. Typically occurs in patients over 50 years. The clinical features vary widely depending on the vascular territories involved in each patient. The classic symptoms are headache, fever, rheumatic polymyalgia, scalp tenderness, visual impairment and jaw claudication. Scalp necrosis is a rare presentation in GCA, there are approximately 100 cases reported in the literature to date; it is associated with severe disease and complications, such as visual loss, tongue necrosis and high mortality rate. We report the case of an 86-year-old female who attended to the dermatology outpatient clinic with bilateral scalp necrosis. Four months prior to presentation she had additional complaints of bilateral temporal headache and jaw claudication, followed by visual loss. The GCA diagnosis was suspected based on cutaneous findings, leading to a comprehensive evaluation, definitive histopathological confirmation and appropriate treatment. This case report and literature review allows highlight the importance of considering the diagnosis of GCA in elderly patients with a newonset headache or change in a pre-existing headache pattern, as early diagnosis and prompt treatment are essential to prevent complications.