Could SARS-CoV-2 infection trigger giant cell arteritis?
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Investigators report a possible case of giant cell arteritis (GCA) following SARS-CoV-2 infection. An otherwise healthy 50-year-old man 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 a 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 a 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.

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 spontaneous resolution. COVID-19 and GCA can have overlapping symptoms, which have 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.