The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Stephanie V. Sherman, M.D., Editor

Tongue Necrosis in Giant-Cell Arteritis

A B

A
74-year-old woman presented to the emergency department Baptiste Dilly, M.D.
with a 3-day history of headache and tongue swelling with associated pain, Charlene Bomahou, M.D.
as well as several hours of blindness in the right eye. On physical examina- Centre Hospitalier Intercommunal
tion, the tongue was discolored and ulcerated (Panel A), and the right temporal Elbeuf–Louviers–Val de Reuil
artery was thickened. Laboratory studies revealed an erythrocyte sedimentation Saint-Aubin-lès-Elbeuf, France
baptiste.dilly@chi-elbeuf-louviers.fr
rate of 42 mm per hour (reference value, <42) and a C-reactive protein level of
169 mg per liter (reference range, 0 to 5). Biopsy specimens of the temporal arteries
showed giant cells and an inflammatory infiltrate throughout the vessel wall,
findings that confirmed a diagnosis of giant-cell arteritis. Lingual infarction is a
rare complication of giant-cell arteritis, and this condition should be considered
in the differential diagnosis of tongue necrosis. The patient was admitted to the
hospital and received tocilizumab and high-dose glucocorticoids. Her vision re-
turned, and she was discharged, with a plan to continue a prolonged tapering of
the glucocorticoid dose. At a follow-up visit 2 months after presentation, the
tongue necrosis had abated (Panel B).
DOI: 10.1056/NEJMicm2105150
Copyright © 2021 Massachusetts Medical Society.

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