Dysphagia and a beginning lockjaw – a differential diagnosis often forgotten

Introduction:

The giant cell arteritis ist the most common systemic vasculitis and characterized by a granulomatous inflammation of blood vessels with a wide range of symtoms. A typical patient ist female and about 70 years old. The main symptoms are strong headaches and deterioration of the general condition. It seldom manifests only in ENT.

Case presentation:

A 81 year old women presents herself with dysphagia, a sore throat, a beginning lockjaw, deterioration of the general condition, muscle aches and a constant headache. The symptomy exist for about two weeks. A oral antibiosis had not helped.

The physical examination only showed a restricted mouth opening e.g. caused by pain. There was no evidence of an abscess in the CT scan, the neuroimaging showed no anomalies. A chronic infection could be ruled out as well as a hemato-oncological disease. The erythrocyte sedimentation rate is highly increased. There are no elevated levels of autoantibodies. In the synopsis the giant cell arteritis war diagnosed.

Under intravenous treatment with prednisolone the patient showed a nearly complete remission and decrease of all symptoms in the ENT area within 24h. For long-term management oft the disease tocilizumab was prescribed.

Conclusions:

- The callenge ist the diagnosis due to little known intial manifestation in the ENT area: Claudicatio masticatoria, claudicatio of swallowing, lockjaw

- possible leads: elevated levels of CRP, normal leukocytes, extremely elevated ESR, no autoantibodies

Berit Bögershausen

Klinik für HNO, UKSH Campus Lübeck,

Ratzeburger Allee 160, 23538

Lübeck

eMail: [e-mail]

Publikationsverlauf

Publikationsdatum:
12. Juni 2019 (online)