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A physical examination revealed a well-defined necrotic, ulcerated plaque in the right parietal region of his scalp and three other satellite lesions of identical characteristics (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The laboratory tests performed revealed an erythrocyte sedimentation rate (ESR) of 39 mm/h and C-reactive protein (CRP) levels of 36.5 mg/dl. Moreover, a histopathological study showed intense lymphocytic obliterating endarteritis and a giant cell granulomatous reaction located adjacent to the internal elastic lamina (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). A bilateral arterial ultrasound showed parietal thickening of both temporal arteries and their main branches (occipital and parietal), with a wall thickness of up to 0.7 mm and a thin hypoechogenic halo (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Based on the above findings, we reached a diagnosis of giant cell arteritis (GCA) and consequently started treatment with methylprednisolone 500 mg pulses every 24 h for three days and local dressings with collagenase and mupirocin, achieving a good clinical response. Scalp necrosis is a rare complication of GCA, although it can occasionally be its only presentation. This presentation of the condition is associated with increased morbidity and mortality, especially if the diagnosis is delayed and a multidisciplinary approach including systemic treatment with high doses of corticosteroids and an adequate management of the skin necrosis, which may even require debridement and subsequent surgical coverage, is not applied early.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Linares-González L, Ródenas-Herranz T, Vera-Álvarez S, Ruiz-Villaverde R. Necrosis dolorosa parietal masiva. Med Clin (Barc). 2021;156:418.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 432 "Ancho" => 900 "Tamanyo" => 120700 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 438 "Ancho" => 1333 "Tamanyo" => 138947 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000008/v1_202104180843/S238702062100142X/v1_202104180843/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000008/v1_202104180843/S238702062100142X/v1_202104180843/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062100142X?idApp=UINPBA00004N" ]
Journal Information
Vol. 156. Issue 8.
Pages 418 (April 2021)
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Vol. 156. Issue 8.
Pages 418 (April 2021)
Image in medicine
Massive painful parietal necrosis
Necrosis dolorosa parietal masiva
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