舌の疼痛を契機に診断に至った巨細胞性動脈炎の1例

• Published in: 日本口腔外科学会雑誌 Vol. 69; no. 3; pp. 158 - 163
• Main Authors: 蒲原, 麻菜, 合島, 怜央奈, 中山, 雪詩, 山下, 亮, 檀上, 敦, 山下, 佳雄
• Format: Journal Article
• Language: Japanese
• Published: 公益社団法人 日本口腔外科学会 20.03.2023
• Subjects: ステロイドパルス療法; 大動脈壁の肥厚; 巨細胞性動脈炎; 舌の疼痛; 舌壊死
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.69.158

Giant cell arteritis(GCA) is a granulomatous arteritis containing giant cells that occur in the major branches of the aorta. Headache is frequently the first symptom, but oral symptoms may precede it. We report a case where giant cell arteritis presented as pain and swelling of the tongue with necrosis over time.　The patient was a 78-year-old woman. She became aware of tongue pain and swelling from June 2019 and visited a nearby dental clinic. Her symptoms remained unimproved and was referred to our department in the same month for detailed examination and treatment. At her first visit, a painful, poorly-marginated dark purple mass w as found extending from the left l ateral edge of tongue to the proglossis. A vascular a nomaly of the tongue was suspected, and contrast-enhanced MRI was performed but did not lead to a diagnosis. One week later, necrotic lesions were observed on her tongue and a blood test showed elevated inflammatory markers. A systemic disease was suspected, and medical examination at our hospital led to the diagnosis of GCA. Steroid treatment and remission maintenance therapy with tocilizumab were performed. Two years and six months have passed since the start of treatment, with no recurrence of the symptoms.