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Visual disturbance with systemic symptoms: old lessons revisited.
Megan E Hume1, Peter M Fernandes2,3, Kirsty MacLean4
1NHS Lothian, Edinburgh, UK.
BMJ Case Reports
|November 1, 2016
Summary
Giant cell arteritis (GCA) can mimic other conditions. This case highlights bacterial endocarditis presenting with atypical GCA symptoms, emphasizing broader differential diagnoses for visual disturbances.
Area of Science:
- Internal Medicine
- Cardiology
- Rheumatology
Background:
- Giant cell arteritis (GCA) is a vasculitis often presenting with headache and visual disturbances.
- Steroid therapy is the mainstay for GCA, but can complicate diagnosis.
Observation:
- A retired physician presented with visual disturbance, headache, and malaise, initially suspected as GCA.
- The patient had a history of heart valve disease and developed worsening systemic symptoms.
Findings:
- Initial response to steroids and temporal artery biopsy supported GCA, but visual symptoms were atypical.
- Bacterial endocarditis was diagnosed, with retinal emboli explaining the visual disturbance.
- Steroid use limited temporal artery biopsy interpretation.
Implications:
- This case underscores the importance of considering bacterial endocarditis in patients with atypical GCA symptoms.
- Echocardiography and blood cultures are crucial for diagnosing endocarditis in complex cases.
- Broadening differential diagnoses for headache and visual disturbance is essential.
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