Acute Pancreatitis Revealing Giant Cell Arteritis

Introduction: Giant cell arteritis (GCA) is a primary granulomatous vasculitis of large caliber arteries, with typically segmental and focal involvement, and predominant in cephalic territory. Digestive complications during this disease are rare and far dominated by mesenteric ischemia. Pancreatic involvement remains exceptional and unusual. We report an original observation of acute pancreatitis inaugural of GCA.

Case report: A 62-year-old patient with no pathological medical history was explored for acute abdominal pain. Biological and radiological investigations led to grade A acute pancreatitis. Subsequent etiological investigations did not reveal any underlying etiology, in particular biliary, metabolic, tumoral, malformative, or medicinal. Computed tomography showed thoracic aortitis whose subsequent investigations related to an evolutive GCA: erythrocyte sedimentation rate at 100 mmH1, absence of left temporal pulse and appearance of arteritis with giant cell and fragmentation of the internal elastic lamina at the biopsy of the temporal artery. Ophthalmological examination was normal and anti-phospholipid antibodies were negative. The patient was treated with oral corticosteroid therapy at a dose of 0.7 mg /kg/day and acetylsalicylic acid at a dose of 100 mg/day with favorable evolution.

Conclusion: Our observation is characterized by the inaugural character of the disease by this digestive complication, classically exceptional and unusual during GCA. A pancreatic localization of vasculitis is the most plausible mechanism for this pancreatitis. It is thus advisable to evoke the GCA in front of a pancreatitis which does not prove itself, in particular in the elderly.

Keywords: Acute pancreatitis, Giant Cell Arteritis, Horton’s disease, Vasulitis, Angiitis.