Giant cell arteritis causing aortic dissection and acute hypertension

Case report

A 74 year old woman was referred because of general malaise and hypertension. During the previous months she had reported fatigue, lack of appetite and weight loss, and muscle weakness. About three weeks before admission she had had sudden onset abdominal pain and diarrhoea, for which no medical aid was sought and which subsided spontaneously after a few days. Her medical history was unremarkable. In particular, her blood pressure had been only mildly raised (160/90 mm Hg, measured repeatedly during previous years, most recently two months before admission).

On examination she had severe hypertension (215/125 mm Hg) but no other abnormalities. Results of vascular, funduscopic, and abdominal examination were normal. Routine laboratory tests showed a raised erythrocyte sedimentation rate (85 mm/h), low plasma sodium (131 mmol/l) and potassium (2.8 mmol/l), moderately raised serum creatinine (111 μmol/l), and mild chronic metabolic alkalosis (arterial pH 7.51, bicarbonate 32 mmol/l). Urinary potassium concentration was 51 mmol/l, and there …