Cargando…

Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy

Giant cell arteritis (GCA) is a rare inflammatory vasculitis of unknown cause that involves large and medium arteries. Arteritic anterior ischemic optic neuropathy (AAION) is attributed to vascular occlusion of the posterior ciliary arteries (PCAs) which supply the optic nerve head (ONH). AAION is t...

Descripción completa

Detalles Bibliográficos
Autor principal: Mandura, Rahaf A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8387793/
https://www.ncbi.nlm.nih.gov/pubmed/34462685
http://dx.doi.org/10.7759/cureus.16653
_version_ 1783742516314505216
author Mandura, Rahaf A
author_facet Mandura, Rahaf A
author_sort Mandura, Rahaf A
collection PubMed
description Giant cell arteritis (GCA) is a rare inflammatory vasculitis of unknown cause that involves large and medium arteries. Arteritic anterior ischemic optic neuropathy (AAION) is attributed to vascular occlusion of the posterior ciliary arteries (PCAs) which supply the optic nerve head (ONH). AAION is the most common ophthalmic complication of GCA and can cause sudden and irreversible loss of vision with a high risk of involvement of the second eye. A 57-year-old female patient presented with unilateral sudden onset visual loss in the right eye (OD) for two days. It was accompanied by severe right-sided headache and scalp tenderness on the right temple, neck as well as the presence of jaw pain over the past three months. Visual acuity (VA) was hand motion (HM) OD, and 20/20 in the left eye (OS). Fundus examination revealed diffuse swollen optic disc with pallid "chalky white" appearance OD and normal healthy optic disc OS. A dramatically elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found. Therefore, a diagnosis of GCA was made, and immediate IV methylprednisolone was started followed by oral prednisone doses. A right temporal artery (TA) biopsy was done later and was negative. On follow-up, VA has maintained at HM level OD, and no involvement of the second eye occurred. GCA is a rare form of vasculitis that can be difficult to diagnose especially in the setting of negative TA biopsy. We support the evidence that negative TA biopsy does not rule out clinically suspected GCA with elevated ESR and CRP and recommend keeping a low index of suspicion as immediate treatment is required to prevent irreversible vision loss.
format Online
Article
Text
id pubmed-8387793
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-83877932021-08-29 Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy Mandura, Rahaf A Cureus Ophthalmology Giant cell arteritis (GCA) is a rare inflammatory vasculitis of unknown cause that involves large and medium arteries. Arteritic anterior ischemic optic neuropathy (AAION) is attributed to vascular occlusion of the posterior ciliary arteries (PCAs) which supply the optic nerve head (ONH). AAION is the most common ophthalmic complication of GCA and can cause sudden and irreversible loss of vision with a high risk of involvement of the second eye. A 57-year-old female patient presented with unilateral sudden onset visual loss in the right eye (OD) for two days. It was accompanied by severe right-sided headache and scalp tenderness on the right temple, neck as well as the presence of jaw pain over the past three months. Visual acuity (VA) was hand motion (HM) OD, and 20/20 in the left eye (OS). Fundus examination revealed diffuse swollen optic disc with pallid "chalky white" appearance OD and normal healthy optic disc OS. A dramatically elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found. Therefore, a diagnosis of GCA was made, and immediate IV methylprednisolone was started followed by oral prednisone doses. A right temporal artery (TA) biopsy was done later and was negative. On follow-up, VA has maintained at HM level OD, and no involvement of the second eye occurred. GCA is a rare form of vasculitis that can be difficult to diagnose especially in the setting of negative TA biopsy. We support the evidence that negative TA biopsy does not rule out clinically suspected GCA with elevated ESR and CRP and recommend keeping a low index of suspicion as immediate treatment is required to prevent irreversible vision loss. Cureus 2021-07-27 /pmc/articles/PMC8387793/ /pubmed/34462685 http://dx.doi.org/10.7759/cureus.16653 Text en Copyright © 2021, Mandura et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Ophthalmology
Mandura, Rahaf A
Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy
title Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy
title_full Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy
title_fullStr Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy
title_full_unstemmed Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy
title_short Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy
title_sort giant cell arteritis presenting as unilateral arteritic anterior ischemic optic neuropathy
topic Ophthalmology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8387793/
https://www.ncbi.nlm.nih.gov/pubmed/34462685
http://dx.doi.org/10.7759/cureus.16653
work_keys_str_mv AT mandurarahafa giantcellarteritispresentingasunilateralarteriticanteriorischemicopticneuropathy