A case of giant cell arteritis complicated by polymyalgia rheumatica with scalp necrosis and refractory jaw claudication.

Scalp necrosis is a rare complication of giant cell arteritis; however, it is a predictor of severe disease. In this case study, a patient presented with giant cell arteritis complicated by polymyalgia rheumatica with scalp necrosis. An 86 year-old woman was admitted to the hospital for pulsating headache, scalp pain, jaw claudication, and generalized pain. Bilateral temporal arteries were found to be distended and pulseless, and scalp necrosis was observed in the parietal region. Simultaneous high-resolution contrast-enhanced magnetic resonance imaging sequences of the head, shoulder, and hip showed staining around the bilateral shallow temporal arteries, shoulder, and hip joints, which was confirmed as giant cell arteritis with polymyalgia rheumatica using other examination findings. After treatment with early induction remission therapy, scalp necrosis healed but jaw claudication persisted. Six months after the start of treatment, scalp necrosis was cured to full hair growth. Despite remission induction therapy combined with tocilizumab, the patient had persistent jaw claudication for several months. At that time, a high-resolution contrast-enhanced magnetic resonance imaging re-examination was useful in assessing disease activity. Giant cell arteritis with scalp necrosis may cause prolonged jaw claudication reflecting the progression of ischemic lesions, whereas the disease activity can be accurately assessed by combining magnetic resonance imaging studies.