Vasculitis/giant cell arteritis as a rare cause of unexplained tongue swelling - case report and comparison with current literature

Introduction The cause of acute tongue swelling is known to be not only the allergic but also the hereditary, the drug-induced, the idiopathic or lymphoproliferative angioedema. Furthermore, inflammations or abscesses, poisoning or the Melkersson-Rosenthal syndrome must be considered.

Methods/results clinical case report, literature research Case description: The primary presentation of the 78-year-old female patient was due to acute tongue swelling and a burning tongue as well as a slight buccal and medial eyelid edema. Infect-associated edema, acute facial edema in the past, allergies or ACE-inhibitor or Sartan intake did not exist. Temporal pain or a temporary loss of vision did not occur at any time. Prednisolone, antihistamines and antibiotics were administered. During the course a livid degeneration of the left half of the tongue was visible, in addition sudden visual disturbances on both sides occurred fourteen days later, finger counting was no longer possible. It was presumably a partial occlusion of the central retinal arteries or the ciliary arteries on both sides. Histologically, a florid arteritis temporalis respectively a giant cell arteritis could be confirmed by taking a sample of the temporal artery as the cause of a thromboembolic event in the area of the left half of the tongue. The therapy was performed with pulsatile cortisone therapy as well as methotrexate.

Conclusion After the exclusion of most of the typical causes of tongue swelling or edema, a thrombosis must be considered, which should be followed up by further diagnosis. The manifestation of vasculitis in the area of the lingual artery has so far been described in only a few case reports.

Poster-PDF A-1694.PDF

Publication History

Article published online:
10 June 2020