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Case Report: Masquerading Large-vessel Giant Cell Arteritis

Jacquier, Paul MD1; Wuarin, Raphael MD1; Chizzolini, Carlo MD2; Thumann, Gabriele MD1; Steffen, Heimo MD1; Chronopoulos, Argyrios MD1*

doi: 10.1097/OPX.0000000000001151
Reports

SIGNIFICANCE Large-vessel giant cell arteritis (GCA) can be a diagnostic dilemma for the eye care provider because it may not involve the typical cranial arteries. When any of its potential ocular complications are diagnosed, it is important to consider this unusual form of GCA.

PURPOSE To report an unusual ophthalmic presentation of large-vessel GCA with sequential bilateral anterior ischemic optic neuropathy and branch retinal artery occlusion.

METHODS A 65-year-old previously healthy woman experienced sequential bilateral anterior ischemic optic neuropathy with branch retinal artery occlusion in the absence of other signs and symptoms suggestive of cranial GCA.

RESULTS Extensive workup, including temporal artery biopsy, failed to demonstrate vascular inflammation suggestive of GCA or vascular abnormalities, such as atheromatous plaques, but coincidentally revealed a breast tumor, which was excised. Positron emission tomography scan was performed revealing distinct hypermetabolism of the thoracic and abdominal aorta consistent with large-vessel GCA, and corticosteroid therapy was initiated.

CONCLUSIONS Large-vessel GCA is an underdiagnosed and undertreated type of GCA that does not typically affect the cranial arteries but rather larger proximal aortic branches. When associated with ocular complications, it can be a puzzling diagnostic dilemma for the eye care provider.

1Ophthalmology Service, University Hospitals and School of Medicine, Geneva, Switzerland

2Immunology and Allergy, University Hospitals and School of Medicine, Geneva, Switzerland *aris_c@web.de

Submitted: February 23, 2017

Accepted: August 15, 2017

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a conflict of interest.

Author Contributions:

Authors PJ and RW have contributed equally and should be considered co–first authors. Data Curation: PJ, RW, AC; Investigation: PJ, HS, AC; Writing – Original Draft: RW, CC, GT, AC; Writing – Review & Editing: RW, CC, AC; Conceptualization: AC.

© 2017 American Academy of Optometry