A rare case of temporal arteritis in a young Indian male

A 25-year-old male developed progressively increasing bilateral temporal headache and swelling in his left temporal region. No other cranial, visual, or other vascular symptoms or physical signs were noted. The evaluation revealed normal routine laboratory parameters and inflammatory markers. Immunological and viral markers' workup was also normal. However, ultrasonography with color Doppler revealed focal areas of dilatation and narrowing with homogenous, hypoechoic wall thickening toward the luminal side of the frontal branch of the left temporal artery, both in longitudinal and transverse planes. Surrounding areas showed minimal inflammatory changes which were further reconfirmed by computed tomography. Left temporal artery biopsy showed thickening of the tunica media and adventitia with the fragmentation of the internal elastic membrane. Moderate lymphocytic, neutrophilic, and histiocytic infiltrations were seen in intima and media. No necrosis or giant cells were seen. A diagnosis of temporal arteritis (TA) was, thus, made. Treatment was initiated with oral prednisolone 30 mg/day and later on maintained on oral methotrexate 15 mg/week (with folate supplementation). The patient achieved symptom relief and no further relapses. TA is typically considered a disease in middle-aged and older patients. It is exceedingly rare in patients who are below 50 years of age with only a few patients reported over the past few decades. Our case-based review highlights and explores the literature that TA in young may have features such as normal inflammatory markers and minimal constitutional features and more of a focal, localized vasculitic presentation which distinguishes it from its elderly counterpart.