Polymyalgia Rheumatica and Systemic Giant Cell Arteritis. Bioptic Findings of the Subclavian Arteries in a Case of Aortic Arch Syndrome

A 64 year old woman complained of aches and stiffness of the neck and the shoulders with fever and E.S.R. increase. A nonsteroid anti-inflammatory treatment was unsuccessful. A clinical examination revealed absence of both radial pulses and presence of murmurs at level of the carotids. The angio graphic findings confirmed an aortic arch syndrome with severe stenosis of the subclavian and axillary arteries. The diagnostic approach, in spite of a negativ ity of the temporal artery biopsy, was for systemic giant cell arteritis with gen eral manifestations of polymyalgia rheumatica. The biopsies of both subclavian arteries, performed during a surgery revascularization, showed a typical giant cell arteritis in acute stage. The histopathological pattern of extratemporal giant cell arteritis obtained by means of a surgical biopsy is really uncommon, being the previous reports performed on necroscopic findings only. In addition this case confirms that polymyalgia rheumatica implies a systemic arteritis even if the clinical and histopathological signs of temporal arteritis are lacking. There fore the temporal artery should be only considered as a particular and incon stant localization of this vasculitis.