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Importance of Clinical Judgment in the Diagnosis of Temporal (Giant Cell) Arteritis

Walvick, Matthew D. DO

Journal of Neuro-Ophthalmology: December 2011 - Volume 31 - Issue 4 - p 397
doi: 10.1097/WNO.0b013e318235f53c
Letter to the Editor

University of California San Francisco Fresno, California

The author reports no conflicts of interest.

I attended the Walsh session at the 35th Annual NANOS meeting in Lake Tahoe in 2011, where the very interesting case report “Occult Temporal Arteritis in a 54-Year-Old Man” by Levin et al (1) was first presented, and I was happy to see it is published.

In 2008, at the Annual Meeting of the American Academy of Ophthalmology, we presented our review of 3,001 temporal artery biopsies performed in the Kaiser Foundation Health Plan from 1997 to 2006. We found 17 of 459 positive biopsies in the 50–59 years old range, and of these, only 3 were in men. What is even more remarkable about the patient reported by Levin et al is that his erythrocyte sedimentation rate, C-reactive protein, and platelet count were normal. At the 2010 Annual Meeting of the American Academy of Ophthalmology, we reported on the prevalence of positive temporal artery biopsies in the setting of normal laboratory values. Of the 459 patients with positive temporal artery biopsies, 20% had a normal erythrocyte sedimentation rate, 5% had a normal C-reactive protein, and 55% had normal platelets. We found that only 2 of the 459 patients had all the 3 laboratory values within normal limits (although not all patients had all 3 tests performed).

Giant cell arteritis is primarily a disease of elderly white women with abnormal laboratory test results supporting the diagnosis. Levin et al remind us that a high index of suspicion is essential in making the diagnosis of giant cell arteritis.

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1. Levin F, Schubert HD, Merriam JC, Blume RS, Odel JG. Occult temporal arteritis in a 54-year-old man. J Neuroophthalmol. 2011;31:153–154
© 2011 Lippincott Williams & Wilkins, Inc.