Results: A 60 year old man presented to the surgeons with an itchy, non-tender lump over his left temple and lethargy. PV was normal. Doppler ultrasound revealed a thrombosed temporal artery. Biopsy confirmed GCA. Three months after stopping two years of prednisolone he represented with sweats, weight loss and an itchy right temple, again without headache. CRP and PV were raised and repeat biopsy showed active GCA. Restarting prednisolone led to resolution of symptoms and inflammatory indices.

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... n 89 year old lady presented to dermatology with an area of scalp necrosis. Biopsy showed inflamed squamous epithelium and granulation. Bloods showed raised PV and anaemia. A history of tongue pain on eating and a non-pulsatile temporal artery were elicited. After starting prednisolone the skin lesion healed and PV normalised. A 68 year old lady presented to the physicians with dizziness, malaise and forearm pain. Examination revealed unrecordable blood pressure, absent radial and brachial pulses. Bloods showed raised PV, CRP, ALP and anaemia. CT angiography showed vasculitis including bilateral axillary artery occlusion, wall oedema of the descending aorta and stenosis of the superior mesenteric artery. Temporal artery biopsy revealed GCA. Prednisolone led to dramatic clinical improvement and normalization of inflammatory indices. Conclusion: Rheumatologists need to ensure other clinicians are aware of atypical presentations of GCA to avoid unnecessary investigation and delays in diagnosis.