Fatal posterior ischemic optic neuropathy

We would like to describe a case report of posterior ischemic optic neuropathy (PION) misdiagnosed as arteritic PION with presumed GCA which leads to missing the correct diagnosis with fatal outcome.

The clinical course of a single patient will be described including presentation, testing,diagnosis and treatment.

An 82-year-old male patient presented with headache and temporal tenderness and mildly elevated ESR and was treated with steroids for presumed diagnosis of GCA. He developed progressive visual loss to NLP in the left eye while on steroids. MRI Brain and orbit showed enhanced mass at orbital apex misdiagnosed as incidental meningioma. Endoscopic biopsy was done and the pathology exam showed aspergillosis. The patient later died after he developed aspergillosis fungal meningitis with subsequent multiple brain infarcts despite appropriate antifungal treatment.

Over-diagnosis of Giant cell arteritis and unwise use of steroids in elderly without appropriate work-ups can lead to unfavorable outcomes including a delay in diagnosis and an exacerbation of occult fungal infection that would manifest weeks later with a fatal outcome.