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A rare case of Mönckeberg medial calcific sclerosis simulating giant cell arteritis

Year 2022, Volume: 47 Issue: 2, 901 - 904, 30.06.2022
https://doi.org/10.17826/cumj.1063305

Abstract

Background: Mönckeberg Medial Calcific Sclerosis (MMCS) is a rare condition that can mimic giant cell arteritis (GCA). It may be misinterpreted as giant cell arteritis by the clinician and cause unnecessary treatments. Therefore, it is a disease that should be differentiated from giant cell arteritis with its clinical, radiological, and pathological findings.
Case Presentation: A 56-year-old female patient was admitted to our clinic with sudden unilateral vision loss on the right, pain in the right temporal artery trace, scalp sensitivity in the section corresponding to that area, difficulty chewing, and temporal artery sensitivity. He had a history of hemodialysis for 13 years due to hypertension, osteoporosis, a history of renal stones, and end-stage renal failure. In routine blood tests, White Blood Cell: 7.86X109/L, Hemoglobulin: 10.9 g/dL, C-reactive protein: 3.03 mg/L, Erythrocyte sedimentation rate: 53 mm/hour came. As a result of temporal artery biopsy performed for GCA, absence of giant cells, absence of epithelioid histiocytes, absence of pathological findings in the internal elastic lamina, diffuse calcification in the tunica media, and sclerosis was diagnosed as MMCS.
Conclusions: In the literature, 4 case reports resemble giant cell arteritis and are diagnosed as MMCS. This case report is a rare case report showing that MMCS can completely mimic GCA findings.

References

  • Referans1. Cuevas Castillo F J, Sujanani S, Chetram V K, et al. (July 15, 2020) Monckeberg Medial Calcific Sclerosis of the Temporal Artery Masquerading as Giant Cell Arteritis: Case Reports and Literature Review. Cureus 12(7): e9210. DOI 10.7759/cureus.9210
  • Referans2. Hunder GG, Bloch DA, Michel BA, et al.: The American College of Rheumatology 1990 criteria for classifying giant cell arteritis. Arthritis Rheum. 1990, 33:1122-1128. 10.1002/art.1780330810
  • Referans3. Schmidt WA, Kraft HE, Vorpahl K, Völker L, Gromnica-Ihle EJ: Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med. 1997, 337:1336-1342. 10.1056/NEJM199711063371902
  • Referans4. Lanzer P, Boehm M, Sorribas V, et al.: Medial vascular calcification revisited: review and perspectives. Eur Heart J. 2014, 35:1515-1525. 10.1093/eurheartj/ehu163
  • Referans5. Lachman AS, Spray TL, Kerwin DM, Shugoll GI, Roberts WC. Medial calcinosis of Mönckeberg. A review of the prob­ lem and a description of a patient with involvement of periph­ real, visceral and coronary arteries. Am J Med 1977; 63: 615­ 22.
  • Referans6. Meema HE, Oreopoulos DG, Rapoport A. Serum magnesium level and arterial calcium cation in end­stage renal disease. Kidney Int 1987; 32: 388­94.
  • Referans7. Silbert S, Lippmann HI: Mönckeberg's arterioclerosis. JAMA 1955, 151:1176-79.
  • Referans8. Castling B, Bhatia S, Ahsan F. Mönckeberg's arteriosclerosis: vascular calcification complicating microvascular surgery. Int J Oral Maxillofac Surg 2015; 44: 34­6.
  • Referans9. Lehto S, Niskanen L, Suhonen M, Ro ̈nnemaa T, Laakso M. Medial artery calcification: a neglected harbinger of cardiovascular complications in non-insulin-dependent diabetes mellitus. Arterioscler Thromb Vasc Biol 1996;16:978 –093.
  • Referans10. Carlos Eduardo Barra Couri, Geruza Alves da Silva, José Antônio Baddini Martinez, Francisco de Assis Pereira and Francisco José Albuquerque de Paula. Mönckeberg's sclerosis – is the artery the only target of calcification? BMC Cardiovascular Disorders 2005, 5:34 doi:10.1186/1471-2261-5-34
  • Referans11. Bienvenido V Castillo JR, Elise Torczynski Deepak P Edward. Monckeberg’s sclerosis in temporal artery biopsy specimens. Br J Ophthalmol 1999;83:1088–1095.
  • Referans12. Peter Lanzer, Manfred Boehm, Victor Sorribas, Marc Thiriet, Jan Janzen, Thomas Zeller, Cynthia St Hilaire, Catherine Shanahan. Medial vascular calcification revisited: review and perspectives . European Heart Journal (2014) 35, 1515–1525 doi:10.1093/eurheartj/ehu163.
  • Referans13. Tohru Kimura, Kengo Inaka. Arterial medial calcification (Mönckeberg’s sclerosis) with chronic renal disease in a zoo-kept Southern tamandua (Tamandua tetradactyla). International Journal of Veterinary Science and Medicine 2021, VOL. 9, NO. 1, 1–6 https://doi.org/10.1080/23144599.2021.1899408.

Dev hücreli arteriti taklit eden nadir bir Mönckeberg medial kalsifik skleroz olgusu

Year 2022, Volume: 47 Issue: 2, 901 - 904, 30.06.2022
https://doi.org/10.17826/cumj.1063305

Abstract

Background: Mönckeberg Medial Calcific Sclerosis (MMCS) is a rare condition that can mimic giant cell arteritis (GCA). It may be misinterpreted as giant cell arteritis by the clinician and cause unnecessary treatments. Therefore, it is a disease that should be differentiated from giant cell arteritis with its clinical, radiological, and pathological findings.
Case Presentation: A 56-year-old female patient was admitted to our clinic with sudden unilateral vision loss on the right, pain in the right temporal artery trace, scalp sensitivity in the section corresponding to that area, difficulty chewing, and temporal artery sensitivity. He had a history of hemodialysis for 13 years due to hypertension, osteoporosis, a history of renal stones, and end-stage renal failure. In routine blood tests, White Blood Cell: 7.86X109/L, Hemoglobulin: 10.9 g/dL, C-reactive protein: 3.03 mg/L, Erythrocyte sedimentation rate: 53 mm/hour came. As a result of temporal artery biopsy performed for GCA, absence of giant cells, absence of epithelioid histiocytes, absence of pathological findings in the internal elastic lamina, diffuse calcification in the tunica media, and sclerosis was diagnosed as MMCS.
Conclusions: In the literature, 4 case reports resemble giant cell arteritis and are diagnosed as MMCS. This case report is a rare case report showing that MMCS can completely mimic GCA findings.

References

  • Referans1. Cuevas Castillo F J, Sujanani S, Chetram V K, et al. (July 15, 2020) Monckeberg Medial Calcific Sclerosis of the Temporal Artery Masquerading as Giant Cell Arteritis: Case Reports and Literature Review. Cureus 12(7): e9210. DOI 10.7759/cureus.9210
  • Referans2. Hunder GG, Bloch DA, Michel BA, et al.: The American College of Rheumatology 1990 criteria for classifying giant cell arteritis. Arthritis Rheum. 1990, 33:1122-1128. 10.1002/art.1780330810
  • Referans3. Schmidt WA, Kraft HE, Vorpahl K, Völker L, Gromnica-Ihle EJ: Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med. 1997, 337:1336-1342. 10.1056/NEJM199711063371902
  • Referans4. Lanzer P, Boehm M, Sorribas V, et al.: Medial vascular calcification revisited: review and perspectives. Eur Heart J. 2014, 35:1515-1525. 10.1093/eurheartj/ehu163
  • Referans5. Lachman AS, Spray TL, Kerwin DM, Shugoll GI, Roberts WC. Medial calcinosis of Mönckeberg. A review of the prob­ lem and a description of a patient with involvement of periph­ real, visceral and coronary arteries. Am J Med 1977; 63: 615­ 22.
  • Referans6. Meema HE, Oreopoulos DG, Rapoport A. Serum magnesium level and arterial calcium cation in end­stage renal disease. Kidney Int 1987; 32: 388­94.
  • Referans7. Silbert S, Lippmann HI: Mönckeberg's arterioclerosis. JAMA 1955, 151:1176-79.
  • Referans8. Castling B, Bhatia S, Ahsan F. Mönckeberg's arteriosclerosis: vascular calcification complicating microvascular surgery. Int J Oral Maxillofac Surg 2015; 44: 34­6.
  • Referans9. Lehto S, Niskanen L, Suhonen M, Ro ̈nnemaa T, Laakso M. Medial artery calcification: a neglected harbinger of cardiovascular complications in non-insulin-dependent diabetes mellitus. Arterioscler Thromb Vasc Biol 1996;16:978 –093.
  • Referans10. Carlos Eduardo Barra Couri, Geruza Alves da Silva, José Antônio Baddini Martinez, Francisco de Assis Pereira and Francisco José Albuquerque de Paula. Mönckeberg's sclerosis – is the artery the only target of calcification? BMC Cardiovascular Disorders 2005, 5:34 doi:10.1186/1471-2261-5-34
  • Referans11. Bienvenido V Castillo JR, Elise Torczynski Deepak P Edward. Monckeberg’s sclerosis in temporal artery biopsy specimens. Br J Ophthalmol 1999;83:1088–1095.
  • Referans12. Peter Lanzer, Manfred Boehm, Victor Sorribas, Marc Thiriet, Jan Janzen, Thomas Zeller, Cynthia St Hilaire, Catherine Shanahan. Medial vascular calcification revisited: review and perspectives . European Heart Journal (2014) 35, 1515–1525 doi:10.1093/eurheartj/ehu163.
  • Referans13. Tohru Kimura, Kengo Inaka. Arterial medial calcification (Mönckeberg’s sclerosis) with chronic renal disease in a zoo-kept Southern tamandua (Tamandua tetradactyla). International Journal of Veterinary Science and Medicine 2021, VOL. 9, NO. 1, 1–6 https://doi.org/10.1080/23144599.2021.1899408.
There are 13 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Letter to the Editor
Authors

Burak Okyar 0000-0002-9028-9930

Bekir Torun 0000-0002-9117-9514

Fatih Albayrak 0000-0002-6052-3896

Sezen Koçarslan 0000-0002-3512-1588

Fatih Yıldız 0000-0003-3628-8870

Gözde Yıldırım Çetin 0000-0001-9680-7535

Publication Date June 30, 2022
Acceptance Date February 27, 2022
Published in Issue Year 2022 Volume: 47 Issue: 2

Cite

MLA Okyar, Burak et al. “A Rare Case of Mönckeberg Medial Calcific Sclerosis Simulating Giant Cell Arteritis”. Cukurova Medical Journal, vol. 47, no. 2, 2022, pp. 901-4, doi:10.17826/cumj.1063305.