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The enigma of giant cell arteritis: multidisciplinary management of two cases
A S Gurwood1, R Brilliant, K A Malloy
1Pennsylvania College of Optometry, Philadelphia, USA.
Insights
Giant cell arteritis, a large artery inflammation, presents diagnostic challenges. Early recognition of symptoms like headache and vision changes is crucial to prevent vision loss.
Area of Science:
- Vascular Inflammation
- Arterial Diseases
Background:
- Giant cell arteritis (GCA) is a chronic granulomatous inflammation affecting large and medium-sized arteries, particularly cranial arteries.
- It predominantly affects older individuals and presents with diverse symptoms, leading to diagnostic complexities.
Observation:
- Two cases illustrate misdiagnosis of GCA, with initial symptoms including headache, malaise, and decreased visual acuity.
- One patient was misdiagnosed with migraine, and another with a low erythrocyte sedimentation rate (ESR) did not undergo temporal artery biopsy.
Findings:
- GCA symptoms can mimic other conditions like migraine and temporomandibular joint dysfunction.
- Delayed diagnosis in GCA can lead to severe complications, including vision loss.
Implications:
- Accurate and timely diagnosis of GCA is critical for preventing irreversible vision loss.
- Comprehensive patient history, including ocular and constitutional symptoms, is essential for appropriate management of GCA.
Background:
Giant cell arteritis is an enigmatic disease that is characterized by chronic granulomatous inflammation of the walls of large and medium-sized arteries. The process has a predilection for the extradural cranial arteries, which include the ophthalmic and the posterior ciliary arteries. A multisymptom disease of older individuals, giant cell arteritis often manifests challenging issues and diagnostic dilemmas.
Case Reports:
We illustrate two cases with initial symptoms of intermittent headache, malaise, and decreased visual acuity that were incorrectly diagnosed or ultimately misdiagnosed. The first case represents a patient who was diagnosed as having migraine headache and an erythrocyte sedimentation rate (ESR) that was interpreted by the attending physician as too low to warrant temporal artery biopsy. The second case is that of a patient who had a history of headaches, jaw claudication, and numerous medical evaluations.
Conclusion:
Giant cell arteries is an enigmatic disease with multiple manifestations. The differential diagnoses can range from temporal mandibular joint dysfunction to tension headache. Imminent vision loss as a sequelae of this condition warrants careful review of ocular and constitutional history and prompt treatment.
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