Could SARS-CoV-2 infection trigger giant cell arteritis?

Investigators report a possible case of giant cell arteritis (GCA) following SARS-CoV-2 infection.

Case study findings

This paper presents a case of an otherwise healthy 50-year-old man who presented to his dermatologist at a virtual appointment with fever, cough, temporal artery thickening, and a headache. Because this case presented amidst the pandemic, clinicians concluded his symptoms were consistent with a mild case of COVID-19.

He was seen a month later with resolution of COVID-19 symptoms but persistent headaches and jaw pain. His blood test was positive for both COVID-19 IgG and IgM. Erythrocyte sedimentation rate and C-reactive protein were normal, but ultrasound of the right temporal artery suggested arterial wall thickening and inflammation based on the presence of the halo sign, with a normal left side.

An FDG PET scan was performed and showed slight increase in metabolic activity of the abdominal aorta without active vasculitis signs. No steroids were initiated and the patient improved spontaneously; a repeat ultrasound showed resolution of the arterial wall inflammation and improved blood flow.

Conclusions

The authors conclude that the most likely diagnosis was GCA triggered by SARS-CoV-2 infection based on symptoms, COVID-19 positive results, ultrasound and PET scan. The case is not a definitive diagnosis and the authors acknowledge the limitations including the lack of histological confirmation, lack of high inflammatory markers and the spontaneous resolution. COVID-19 and GCA can have overlapping symptoms, which has been previously reported. Nevertheless, if this indeed is GCA triggered by SARS-CoV-2, the clinician should always keep an open mind of virus-precipitating disease. When symptoms appear to be GCA in the context of suspected SARS-CoV-2, both should be assumed and investigated as each can have significant and detrimental effects.