{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T18:30:30Z","timestamp":1767983430484,"version":"3.49.0"},"reference-count":8,"publisher":"SMC Media","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Giant cell arteritis (GCA) is a chronic large-vessel vasculitis that may present with systemic, neurological or ophthalmological manifestations. Lingual and scalp ischaemia are rare but can have severe potential complications that pose a diagnostic challenge and require immediate treatment to prevent irreversible outcomes. We report the case of an 87-year-old woman who initially presented with holocranial headaches and tongue pain with partially detachable whitish plaques. She was diagnosed with GCA based on clinical features, elevated inflammatory markers and ultrasonographic findings of thickened temporal arteries. High-dose corticosteroid therapy was promptly initiated, leading to marked improvement of the reported symptoms. Nevertheless, on day 14 of hospitalisation, she developed septic shock from an abdominal source and subsequently died. This case reports an atypical presentation of GCA \u2013 lingual and scalp ischaemia \u2013 emphasising the need to maintain a high index of suspicion even before these non-classical manifestations. A holistic clinical approach is essential to identify the various possible manifestations of this complex disease. Although tongue and\/or scalp necrosis are rare complications, treatment remains aligned with current GCA guidelines. Most patients respond to corticosteroid therapy, or tocilizumab in cases of steroid-refractory lingual necrosis; non-responders are typically associated with a poorer prognosis.<\/jats:p>","DOI":"10.12890\/2026_006030","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T11:20:26Z","timestamp":1767871226000},"source":"Crossref","is-referenced-by-count":0,"title":["Ischemia of the tongue and scalp as an uncommon presentation of giant cell arteritis"],"prefix":"10.12890","volume":"13","author":[{"given":"Catarina","family":"Santos Reis","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"In\u00eas","family":"Moreira","sequence":"first","affiliation":[{"name":"Department of Immunohematology, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Pratas","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ester","family":"Ferreira","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel","family":"Magalh\u00e3es","sequence":"first","affiliation":[{"name":"Department of Stomatology, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edite","family":"Pereira","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Almeida","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Local Health Unit of S\u00e3o Jo\u00e3o, Porto, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"10.12890\/2026_006030_ref1","doi-asserted-by":"crossref","unstructured":"Farina N, Tomelleri A, Campochiaro C, Dagna L. Giant cell arteritis: update on clinical manifestations, diagnosis, and management. Eur J Intern Med 2023;107:17\u201326. doi: 10.1016\/j.ejim.2022.10 025","DOI":"10.1016\/j.ejim.2022.10.025"},{"key":"10.12890\/2026_006030_ref2","doi-asserted-by":"crossref","unstructured":"Grayson PC, Ponte C, Suppiah R, Robson JC, Gribbons KB, Judge A, et al. DCVAS Study Group. 2022 American College of Rheumatology\/EULAR classification criteria for Takayasu arteritis. Ann Rheum Dis 2022;81:1654\u20131660. doi: 10.1136\/ard-2022-223482","DOI":"10.1002\/art.42324"},{"key":"10.12890\/2026_006030_ref3","doi-asserted-by":"crossref","unstructured":"DeBord LC, Chiu I, Liou NE. Delayed diagnosis of giant cell arteritis in the setting of isolated lingual necrosis. Clin Med Insights Case Rep 2019;12:1179547619857690. doi: 10.1177\/1179547619857690","DOI":"10.1177\/1179547619857690"},{"key":"10.12890\/2026_006030_ref4","doi-asserted-by":"crossref","unstructured":"Cho YM, El Khoury L, Paramo J, Horowitz DM, Li JY, Kello N. Tongue necrosis secondary to giant cell arteritis, successfully treated with tocilizumab: a case report. BMC Musculoskelet Disord 2023;24:382. doi: 10.1186\/s12891-023-06465-z","DOI":"10.1186\/s12891-023-06465-z"},{"key":"10.12890\/2026_006030_ref5","doi-asserted-by":"crossref","unstructured":"Baburaj K, Thekkedath M, Bhasi R. Fulminant giant cell arteritis with tongue autoamputation. Ann Rheumatol Autoimmun 2024;4:55\u201358. doi: 10.4103\/ara.ara_14_24","DOI":"10.4103\/ara.ara_14_24"},{"key":"10.12890\/2026_006030_ref6","doi-asserted-by":"crossref","unstructured":"Brodmann M, Dorr A, Hafner F, Gary T, Pilger E. Tongue necrosis as first symptom of giant cell arteritis (GCA). Clin Rheumatol 2009;28:S47\u2013S49. doi: 10.1007\/s10067-009-1141-z","DOI":"10.1007\/s10067-009-1141-z"},{"key":"10.12890\/2026_006030_ref7","doi-asserted-by":"crossref","unstructured":"Jalaledin DS, Ross C, Makhzoum JP. Rare ischaemic complications of giant cell arteritis: case series and literature review. Am J Case Rep 2022;23:e937565. doi: 10.12659\/AJCR.937565","DOI":"10.12659\/AJCR.937565"},{"key":"10.12890\/2026_006030_ref8","unstructured":"Nesher G, Nesher R, Mates M, Sonnenblick M, Breuer GS. Giant cell arteritis: intensity of the initial systemic inflammatory response and the course of the disease. Clin Exp Rheumatol 2008;26:S30\u2013S34."}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6030\/5047","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6030\/5051","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6030\/5051","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T13:52:19Z","timestamp":1767966739000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/6030"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,8]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.12890\/2026_006030","relation":{"has-manifestation":[{"id-type":"other","id":"1-133-6030-g5047","asserted-by":"subject"},{"id-type":"other","id":"1-133-6030-g5051","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-133","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"value":"2284-2594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,8]]}}}