Splinter Hemorrhage as a Telltale of Active Extra-Cranial Giant Cell Arteritis : A Case Report and Review of the Literature

Rheumatologists and general practitioners as a rule do not examine the nails when giant cell arteritis (GCA) is suspected, and may thus miss a simple yet valuable clinical sign. Splinter hemorrhage (SH) is a non-specific but significant clinical finding that can be seen in a wide range of conditions and by different medical specialists, among others: rheumatologists, infectious diseases specialists, dermatologists, nephrologists and endocrinologists. Rheumatologists usually look at the nail beds in search of SH when there is a suspicion of vasculitis, mostly anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis although SH has been described in other vasculitides as well. SH in GCA has rarely been described. Here are two cases with SH appearing during active disease in patients with extra-cranial GCA, illustrating the value of nail bed assessment and how it may provide important clues.