# Giant Cell Arteritis Mimicking Temporomandibular Disorder: Diagnostic Value of Temporal Artery Halo Sign

## TL;DR

An elderly man's symptoms of jaw fatigue and headache were diagnosed as giant-cell arteritis using a temporal artery halo sign, avoiding the need for a biopsy.

## Contribution

The halo sign in temporal artery ultrasonography is proposed as a practical diagnostic alternative to biopsy for giant-cell arteritis.

## Key findings

- Temporal artery halo sign confirmed giant-cell arteritis in an 89-year-old patient.
- Steroid treatment improved symptoms but failed to prevent sudden bilateral visual loss.
- The halo sign can be a reliable diagnostic tool in older adults suspected of GCA.

## Abstract

Giant-cell arteritis (GCA) involving the temporal arteries primarily affects the older adults, with symptoms that include head pain and tenderness. GCA may mimic temporomandibular disorders by causing jaw opening difficulty. Herein, we report an 89-year-old man who presented with jaw fatigue during meals, frontal headache, and low-grade fever. Examination revealed tenderness and dilatation of the right superficial temporal artery, jaw claudication, an elevated C-reactive protein (8.62 mg/dL), and erythrocyte sedimentation rate of 97 mm/h. Magnetic resonance imaging of the brain showed a small acute infarct. Autoimmune serology and blood culture results were negative. Temporal artery ultrasonography demonstrated a halo sign, and the patient met four of the five American College of Rheumatology criteria, confirming GCA. Treatment with prednisolone (0.5 mg/kg) rapidly improved symptoms and laboratory findings; however, sudden bilateral visual loss occurred despite steroid pulse therapy, and vision did not recover. The findings of this case highlight that, in older adult patients, the halo sign may serve as a practical alternative to temporal artery biopsy for establishing GCA diagnosis.