Clinical Diagnosis of Temporal Arteritis With Seronegative and Negative Biopsy Studies

Giant cell arteritis (GCA), also known as temporal arteritis is the most common of the systemic vasculitides. It occurs in individuals older than 50 years of age and peaks in incidence in the seventh decade. The gold standard for diagnosis of GCA is temporal artery biopsy (TABx) which will show transmural inflammation, but a negative biopsy does not rule out the disease. We present a case of a 66-year-old male with a classic clinical presentation of temporal arteritis with a normal erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and negative bilateral temporal artery biopsies. He was discharged on prednisone. Ten days later, he unilaterally stopped his corticosteroid treatment leading to a recurrence of symptoms and conversion to seropositivity (ESR negative and CRP positive). The objective of this article is to point out that the diagnosis of temporal arteritis is clinical and is not discarded by a negative TABx. Patients with classic clinical manifestations of temporal arteritis but with a negative TABx should be treated aggressively.