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Can lightning strike twice?

Edlira Bendo1, Molly Gilbert, Rod Foroozan

  • 1Neuro-ophthalmology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA 19106, USA.

Survey of Ophthalmology
|May 27, 2008
PubMed
Summary
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Recurrent giant cell arteritis caused vision loss in a patient previously treated for the condition. A positive repeat temporal artery biopsy confirmed the relapse, necessitating prompt intervention.

Area of Science:

  • Ophthalmology
  • Rheumatology
  • Vascular Inflammation

Background:

  • Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium-sized arteries.
  • GCA can lead to severe visual impairment and permanent blindness if not diagnosed and treated promptly.
  • Patients with a history of GCA are at risk for relapse, even after successful treatment and discontinuation of corticosteroids.

Observation:

  • A 73-year-old female presented with acute, 2-day history of decreased visual acuity in her right eye.
  • The patient had a confirmed diagnosis of GCA treated successfully 5 years prior.
  • She had been off corticosteroid therapy for 3 years preceding this new visual decline.

Findings:

  • A repeat temporal artery biopsy was performed and returned positive for GCA.

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  • The positive biopsy in the context of new visual symptoms indicated a relapse of the disease.
  • This suggests that GCA can remain quiescent for extended periods before flaring.

    • Implications:

    • Prompt initiation of high-dose corticosteroids is crucial to prevent further vision loss and potential bilateral involvement.
    • This case highlights the importance of vigilant monitoring and early re-biopsy in patients with a history of GCA presenting with new visual symptoms.
    • Long-term management strategies for GCA may need to consider the possibility of late relapses.