Sixth nerve palsies, temporal artery biopsy, and necrotizing vasculitis

A 79-year-old man with diplopia and weakness was found to have necrotizing vasculitis consistent with polyarteritis nodosa on temporal artery biopsy. Although he had no evidence of visceral involvement from vasculitis, he responded well to corticosteroid therapy. This case illustrates a nosological problem that can occur when dealing with a disease that has diverse clinical manifestations and nonspecific laboratory findings. Moreover, this case demonstrates the value of including a branch artery segment when biopsying the temporal artery.