Scalp necrosis and visual loss in giant cell arteritis: the importance of recognising atypical cutaneous clues

A 70-year-old woman had presented with electric shock-like left hemifacial pain, with bilateral forehead skin plaques, diagnosed as shingles. 2 weeks later, she suddenly lost vision in the left eye. She had left optic disc oedema and bilateral necrotic-looking scalp lesions. Temporal artery biopsy was consistent with active temporal arteritis. Giant cell arteritis (GCA) may rarely present with scalp necrosis due to vasculitis of the facial arteries; the resulting hemifacial pain and atypical scalp rash may be misinterpreted as varicella zoster infection, delaying urgent intervention for GCA.