Isolated Lower Extremity Vasculitis Leading to Progressive Critical Limb Ischemia
Pouria Parsa, MD, Anthony Rios, MD, Brad Grimsley, MD, John F. Eidt, MD, Dennis Gable, MD.
Baylor University Medical Center, Dallas, TX, USA.
BACKGROUND
According to autopsy studies and improving vascular imaging techniques, large vessel involvement of the extremities may be more prevalent than we once thought. The prevalence of lower extremity GCA findings according to the largest series of histologically documented extracranial GCA is 18%. While limb claudication may be present in conjunction with systemic signs of inflammation, classic cranial manifestations, or preexisting diagnosis of PMR on initial diagnosis of GCA, even more rare are patients presenting with isolated lower extremity claudication or ischemia preceding their GCA diagnosis.
CASE REPORT
Our patient is a 67-year-old woman with significant cardiac history who was seen in the emergency department with 3 week history of bilateral lower extremity rest pain. Her workup was significant for bilateral lower extremity occlusive disease with elevated ESR. . She was started on steroids and monitored closely until her inflammatory markers improved. Following resolution of her inflammatory state, she underwent bilateral lower extremity revascularization. A biopsy of the CFA was sent for permanent pathology which was consistent with GCA as shown in figure 1.0. Patient had an uncomplicated post-operative course and discharged to home. Patient was seen in Vascular Surgery clinic in one month following her discharge, she denies claudication or rest pain like symptoms.
CONCLUSIONS
Increased awareness of the different manifestations of GCA is crucial for diagnosis of patients with isolated lower extremity vasculitis. It is imperative that GCA be considered in the differential diagnosis of unexplained lower extremity claudication especially in patients with few risk factors for atherosclerotic disease, rapidly progressive disease, elevated inflammatory markers, and characteristic findings on imaging.
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