Siegrist Streaks in a Case of Biopsy-negative Giant Cell Arteritis: A Case Report

This report features a case of bilateral vision loss due to initially biopsy-negative giant cell arteritis (GCA). A 78-year-old man with polymyalgia rheumatica presented with biopsy-negative GCA and a 2 to 4 week history of profoundly decreased vision bilaterally. Fundus examination of the right eye revealed Siegrist streaks and Amalric triangle sign (ATS), and optical coherence tomography demonstrated paracentral acute middle maculopathy in the left eye. As a result, the patient was admitted for intravenous methylprednisolone for presumed GCA, resulting in visual improvement. However, temporal artery biopsy (TAB) returned negative for arteritis. Due to high clinical suspicion, re-evaluation of biopsy specimens was requested and subsequently confirmed the diagnosis of GCA. This case exemplifies the importance of relying on ocular diagnostics while re-examining confirmatory testing when GCA is strongly suspected. Prompt steroid treatment is essential to prevent permanent visual and systemic sequelae, especially given an initially biopsy-negative TAB.