British Journal of Rheumatology 1994;33:161-164 BILIARY ULTRASTRUCTURAL CHANGES IN THE LIVER IN A CASE OF GIANT CELL ARTERITIS

A 55-yr-old Palestinian man was admitted with a 1-month history of bi-temporal headache, proximal weakness and myal-gia in the lower limbs. Both temporal arteries were swollen and tortuous. There was a moderate degree of cholestatic hepatic dysfunction. Temporal artery biopsy showed typical features of giant cell arteritis. Light microscopic examination of the liver showed no significant abnormality while electron microscopic (EM) examination revealed ultrastructural dam-age to the bile canaliculi. The patient improved dramatically on steroid therapy with normalization of cholestatic dys-function. EM examination of a repeat liver biopsy 8 months later showed complete reversal of the biliary ultrastructural damage. The pathogenesis of the biliary injury remains uncertain. KEY WORDS: Giant cell arteritis, Biliary damage. POLYMYALGIA rheumatica (PMR) and temporal arteritis (TA) are regarded as two different clinical expressions of the same disease process, giant cell arteritis (GCA) [1, 2]. GCA is a generalized vasculitic process with a high predilection in medium- and large-sized arteries of the head and neck [1]. Various other organs includ-ing pulmonary arteries, myocardium, gastrointestina