Case 2 is similar to previously reported cases where there is a presumed giant cell aortitis cause for aortic regurgitation in a patient with a remote history of histologically documented giant cell arteritis of the temporal artery.
Giant cell arteritis is not a rare disease and may affect more than 1 percent of the elderly population. Giant cell arteritis is a systemic disease and may involve the aortic root causing the aortic regurgitation years after the diagnosis of giant cell arteritis of the temporal arteries. The presence of a history of giant cell arteritis of the temporal artery may indicate giant cell arteritis as the cause for newly diagnosed aortic regurgitation. The occurrence of chronic aortic regurgitation in the elderly should raise the awareness of possible previous giant cell arteritis of the temporal arteries. Unfortunately, prolonged treatment with steroids (10 to 18 months) did not prevent subsequent development of severe aortic insufficiency. Discontinuation of steroid treatment may allow a persistent smoldering disease process, ultimately resulting in aortic root dilatation. It is important to provide close clinical follow-up of the patient with giant cell arteritis of the temporal arteries for the development of de novo aortic regurgitation.