Case Report Tongue Necrosis as an Initial Manifestation of Giant Cell Arteritis: Case Report and Review of the Literature Jose R. Zaragoza, Natalia Vernon, and Gisoo Ghaffari Division of Allergy & Immunology, Penn State Hershey Allergy, Asthma & Immunology, 500 University Drive, UPC II, Suite 1300, Hershey, PA 17033, USA Correspondence should be addressed to Gisoo Ghafari; gghafari@hmc.psu.edu Received 12 November 2014; Accepted 7 January 2015 Academic Editor: Suleyman Serdar Koca Copyright © 2015 Jose R. Zaragoza et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Giant cell arteritis (GCA) is a systemic vasculitis of medium and large arteries that mainly afects the external carotid artery. It is a diagnosis of the elderly that typically presents as low-grade fever, temporal tenderness, claudication of the jaw, and in some patients vision loss. In cases where GCA presents with atypical manifestations, the diagnosis may be more diicult, causing a delay in both diagnosis and treatment and ultimately leading to irreversible complications. In this paper, we present an atypical presentation of GCA with symptoms of neck swelling and lingual pain in an elderly female. hese symptoms progressed to bilateral necrosis and eventual dislodgement of the tongue. Lingual necrosis is a severe potential complication in GCA. In patients presenting with lingual swelling, pain, and discoloration, GCA should be suspected and prompt therapy should be initiated to avoid irreversible complications. 1. Introduction Giant cell arteritis is a chronic vasculitis of large and medium sized vessels that commonly afects those above the age of 50 years. It has an estimated incidence of 20 cases per 100,000 individuals and a prevalence of 1 in 500 individuals [1]. Scandinavian and North American females are most commonly afected. Clinical presentation is usually fever, claudication of the jaw, and temporal headache. Less common presenting symptoms include dysphagia, cough, hearing loss, and necrosis of the tongue [2]. he diagnosis of GCA is clinicopathological for which the American College of Rheumatology (ACR) has established classiication criteria. To meet the diagnosis criteria, patients should present at least 3 out of 5 positive indings. he ACR diagnostic tool does not include any lingual symptomatology amongst its criteria [3, 4](Table 1). Lingual necrosis is a known complication of GCA that commonly afects one side of the tongue [5–8]. In a few cases bilateral necrosis has been described and is considered extremely rare due to the rich lingual vascular supply [2, 5, 9– 11]. his paper presents a case of lingual pain and bilateral tongue necrosis secondary to GCA along with a literature review of this rare complication. 2. Case Report A 68-year-old female patient was initially evaluated by her primary care physician for a nonspeciic moderate headache and swelling of the neck for four weeks. She was treated with a course of antibiotics and nonsteroidal anti-inlammatory medications for ten days. Ater completing this therapy, the patient presented to the Emergency Department for acute onset of severe pain and progressive swelling of the tongue that was compromising her speech and deglutition. She was admitted to the hospital and treated with empiric antibiotic therapy and intermittent doses of systemic glucocorticoids for suspected sialadenitis. Progressive swelling of the tongue compromised feeding so the patient was then transferred to a tertiary care institution for further treatment and consulted with the allergy service for evaluation of angioedema as possible culprit on swelling. Patient denied symptoms of fever, malaise, or weight loss. She did not have vision loss, jaw claudication, or temporal Hindawi Publishing Corporation Case Reports in Rheumatology Volume 2015, Article ID 901795, 4 pages http://dx.doi.org/10.1155/2015/901795