Extra-cranial giant cell arteritis: a diagnostic challenge.

### Learning Point for Clinicians Giant cell arteritis often affects extra-cranial vessels and may not present as a classical cranial arteritis. It must be considered in patients over 50 with constitutional symptoms and raised inflammatory markers. Initial investigations are usually non-specific, but positron emission tomography–computed tomography is normally diagnostic. Prompt treatment with corticosteroids is required for this potentially life-threatening condition. A 61-year-old female was referred to our clinic with a 6-week history of fatigue, weight loss and fevers. She also reported epigastric and bilateral buttock pain. She had no medical history and took no medication. Examination revealed epigastric and left groin tenderness without peritonism. Peripheral pulses were intact. Temporal arteries were non-tender and the remaining examination was normal. Initial blood tests revealed a normocytic anaemia (haemoglobin (Hb) 9.1 g/dl), white cell count (WCC) 7.5 × 109/l and platelets (Plts) 331 × 109/l. Inflammatory markers were elevated: erythrocyte sedimentation rate (ESR) 103 mm/h and C-reactive protein (CRP) …