Temporal arteritis with normal erythrocyte sedimentation rate

The erythrocyte sedimentation rate (ESR) is used to differentiate temporal arteritis from other forms of headache in the elderly. Though temporal arteritis can occur with a normal ESR, this is not generally appreciated in primary care. The case reported here is a 74-year-old woman with biopsy-proven temporal arteritis; her ESR was 22 mm/hr. Of note, her hematocrit was more than 40 percent, a condition previously reported to be associated with temporal arteritis and a normal ESR. This discussion focuses on the diagnosis of temporal arteritis and its associated symptoms.