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Klinische Aspekte der Arteriitis temporalis

Verlaufsvarianz bis zu letalen Komplikationen

Clinical aspects of temporal arteritis

Course variations up to fatal complications

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Zusammenfassung

Hintergrund

Die Arteriitis temporalis (AT) zeigt als systemische Vaskulitis sehr variable klinische Krankheitsverläufe, bei der vorübergehende oder permanente Sehstörungen auftreten können.

Patienten und Methode

Es handelt sich um eine retrospektive konsekutive Fallserie von 66 Patienten mit Verdacht auf AT, von denen 65 einer Biopsie der A. temporalis unterzogen wurden. Die Beschwerdesymptomatik, Therapie sowie Komplikationen während des Krankheitsverlaufs wurden verfolgt.

Ergebnisse

Bei 32 (49,2%) von 66 Patienten konnte bei ein- (55,4%) oder beidseitiger (44,6%) Biopsie histopathologisch eine Riesenzellarteriitis nachgewiesen werden. Davon zeigten 3 Patienten (9,4%) schwerwiegende bis letale Folgen: ausgeprägte Ischämien des vertebrobasilären Systems mit konsekutiver Schwerstbehinderung bzw. Exitus bei je 1 Patienten sowie 1 letale Komplikation einer akuten Pankreatitis als Nebenwirkung der systemischen Steroidtherapie.

Schlussfolgerung

Die AT als potenziell lebensbedrohliche Systemerkrankung erfordert eine umsichtige und unverzügliche interdisziplinäre Diagnostik und Behandlung. Bei systemischer Manifestation führt sie zu einer deutlichen Minderung des Allgemeinzustandes, in deren Folge häufig zerebrale ischämische Ereignisse oder Organinfarzierungen auftreten können.

Abstract

Background

Arteritis temporalis (AT) shows a variable course of the disease and may lead to transient or permanent visual loss.

Patients and methods

In a retrospective consecutive case series 66 patients with suspected AT were followed up of which 65 underwent arterial biopsy. Symptoms, therapy and complications were followed up.

Results

Of the patients 32 (49.2%) revealed a positive histological finding in unilateral (55.4%) or bilateral (44.6%) biopsy. Of these 3 (9.4%) suffered a severe or fatal outcome: two with extensive ischemia of the vertebrobasilar system (one fatal) and one patient died due to acute pancreatitis, a rare side effect of systemic steroid therapy.

Conclusion

When systemically apparent, arteritis temporalis can progress to reduction of general health, cerebral ischemia and organ infarction. Therefore, AT is a serious disease requiring interdisciplinary, immediate diagnostics and prompt therapy.

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Authors and Affiliations

  1. Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    A. Brüggemann & M. Müller

  2. Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    K. Holl-Ulrich

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  1. A. Brüggemann
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  2. K. Holl-Ulrich
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  3. M. Müller
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Correspondence to A. Brüggemann.

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Brüggemann, A., Holl-Ulrich, K. & Müller, M. Klinische Aspekte der Arteriitis temporalis. Ophthalmologe 107, 930–936 (2010). https://doi.org/10.1007/s00347-010-2164-1

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