Article Text

  1. M. M. Palau-Collazo1,
  2. W. E. De Jesus-Monge2,
  3. A. Ortiz3,
  4. J. C. Santa4,
  5. N. Villalba3,
  6. J. Leavitt2,
  7. E. I. Cruz-Cuevas2
  1. 1Departments of Medical student
  2. 2Departments of Medicine
  3. 3Departments of Ophthalmology
  4. 4Pathology, University of Puerto Rico School of Medicine, University District Hospital, San Juan, PR.


Background Giant cell arteritis (GCA) is a chronic vasculitis of medium- and large-size vessels, especially the cranial branches of arteries originating from the aortic arch. The most feared complication of GCA is visual loss if not treated promptly. The finding of at least three of the five diagnostic criteria has a sensitivity of 93% and a specificity of 91% for the diagnosis of GCA.

Objective To describe a patient with GCA and its consideration in the differential diagnosis of headache in an elder with risk of visual loss if not treated promptly.

Case Report An 89-year-old woman came to hospital with loss of vision in the left eye since 3 days before arrival. The patient developed a pain that started on the cervical region with radiation to the occipital and frontal head during 3 weeks prior to arrival at hospital. The patient was evaluated by community physicians with imaging tests showing normal findings. On evaluation, the patient had hard and nonpulsatile temporal arteries bilaterally, neurologic dysfunction in the left eye, and elevated erythrocyte sedimentation rate by the Westerngren method (ESR, 122 mm/hr). Corticosteroid therapy was started promptly. On admission to hospital, she was evaluated by the ophthalmology and rheumatology services. Two days after admission, the patient was discharged home with oral daily prednisone and follow-up in rheumatology clinics. A left temporal artery biopsy confirmed the diagnosis.

Discussion The patient had all five diagnostic criteria for GCA: disease onset at or more than 50 years of age, new headache, temporal artery abnormality, ESR at 50 mm/hr or higher, and abnormal artery biopsy. The effective starting dose of corticosteroid should be continued until all reversible symptoms and findings have disappeared and laboratory tests have reverted to normal.

Conclusion GCA must be considered in the differential diagnosis of new headache in an elder. Corticosteroid should be instituted once the diagnosis of GCA is suspected because of increased risk of visual loss. Temporal artery biopsy should be obtained promptly, but its performance is independent of the clinical suspicion and prompt therapy for GCA.

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