Giant cell arteritis (GCA) is a
vasculitis of medium and large sized vessels that occurs most often in people >50 years of age with associated symptoms of
fever,
weight loss,
headache and jaw claudication.
Polymyalgia rheumatica (PMR), which is characterized by aching and stiffness in the shoulders, hip girdle, neck and torso, is intimately associated with GCA, and evidence suggests that GCA and PMR are two phases of the same disease. The occurrence of liver
enzyme abnormalities in either of these conditions is rare. Furthermore, as these conditions occur most commonly in the elderly population who may be subject to
polypharmacy, patients with elevated
aminotransferases due to underlying GCA/PMR may mistakenly have their abnormal liver function tests attributed to
drug-induced liver injury. Given the potential complications of these diseases if left untreated, including
ischemic stroke and
blindness, early recognition and treatment are critical. We report two patients who developed severe cholestatic liver
enzyme elevation, which had been initially attributed to
drug toxicity, but was ultimately caused by large vessel
vasculitis, specifically GCA and PMR.