Spontaneous Remission Of Giant Cell Arteritis: Possible Association With A Preceding Acute Respiratory Infection And Seropositivity To Chlamydia Pneumoniae Antibodies
Maekawa, M., Iwadate, T., Watanabe, K., Yamamoto, R., Imaizumi, T., & Yamakawa, T. (2019). Spontaneous remission of giant cell arteritis: possible association with a preceding acute respiratory infection and seropositivity to Chlamydia pneumoniae antibodies. Nagoya journal of medical science, 81(1), 151–158. https://doi.org/10.18999/nagjms.81.1.151
View Original Source →Abstract
Recent epidemiological or immunopathological studies demonstrate the possible association between giant cell arteritis and infectious agents including Chlamydia pneumoniae. A 62-year-old Japanese man with type 1 diabetes mellitus developed biopsy-proven giant cell arteritis after acute upper respiratory infection. Serological examination indicated concurrent re-infection with C. pneumoniae. Clinical manifestations of the vasculitis subsided within a month without any immunosuppressive therapy, and no relapse was observed for the following 12 months. The natural history of this disease is unclear and spontaneous remission is rarely reported. The self-limiting nature of the infection could contribute to this phenomenon.
Case Details
Disease Location
Arteries
Personal Characteristics
62-year-old man. Medical history of type 1 diabetes mellitus requiring insulin therapy,
Clinical Characteristics
The patient was admitted with fever for 7 days. He experienced a body weight loss of 6 kg during the 3 weeks. Four months before admission, painful erythematous papules developed on the left side of his face, and he was diagnosed with a herpes zoster infection involving the mandibular division of the trigeminal nerve. The patient was treated with antiviral therapy. He had presented to the outpatient department 3 weeks prior to the admission, with a few days of high-grade fever and accompanying malaise, nasal congestion, mild sore throat, and pruritic rash over the truncus, all of which resolved within 5 days. Laboratory test showed anemia, leukocytosis, elevated c-reactive protein levels, elevated erythrocyte sedimentation rate, and hyperglycemia. Contrast-enhanced computed tomography showed arterial wall thickening and elevated density of the surrounding tissue in the bilateral femoral arteries and arteries in the abdominal wall. A gallium scan showed an abnormal accumulation in the bilateral femoral arteries. Temporal artery biopsy revealed the infiltration of inflammatory cells in the arterial wall. The patient was diagnosed with giant cell arteritis (gca). Increased IGG and IGA levels for c. Pneumoniae without increased IGM, suggesting a current reinfection with the microorganism.
Remission Characteristics
The symptoms gradually resolved without any immunosuppressive therapy or antimicrobials; the fever was absent and the myalgia and tenderness along the arteries diminished by the third week of admission. C-reactive protein level and esr had normalized after 5 weeks and 4 months from admission, respectively.
Treatment & Mechanisms
Proposed Remission Mechanisms
The virus or bacteria that causes acute infection could trigger immunological abnormalities; thereafter, autoimmune responses would be modified after eliminating the inciting microorganisms, resulting in spontaneous remission of the autoimmune disease
Clinical Treatment
Biopsy
Non-Clinical Treatment
None reported