A Case of Giant Cell Arteritis Presenting with Headache Diagnosed after Detection of Basilar Artery Stenosis

Abstract

　An 82-year-old man with chronic obstructive pulmonary disease was taking prednisolone at a dose of 8 mg per day. He was referred to our department because of newly developed dull pain extending from the right orbit to the temporal region, which had progressively worsened over the previous month. Due to his immunocompromised status, meningitis was initially suspected and investigated; however, no significant abnormalities were identified. High-grade stenosis of the basilar artery, as revealed by brain magnetic resonance angiography, raised the possibility of giant cell arteritis (GCA) . Following reassessment, the patient met the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for GCA. The rheumatology department initiated tocilizumab treatment, resulting in an improvement in his symptoms. GCA can present as a diagnostic pitfall in patients presenting with headaches and should therefore be considered in the differential diagnosis. Here, we present a case in which MRA findings contributed to the diagnosis of GCA.