Floridly Positive Temporal Artery Biopsy After 4 Months of Steroid Treatment: A Case Report

Case Report

A 78-year-old woman with a history of hypertension and hypercholesterolemia presented with increasing shoulder, neck, and head pain. She described weight loss and listlessness. In the context of a CRP of 45 mg/L, her primary care doctor started the patient on prednisone 60 mg daily dosage. The pain subsided promptly, her CRP normalized, and she regained her original weight. Prednisone dosage was tapered slowly over a period of 3.5 months. As the daily dosage of prednisone reached 5 mg, she began to experience intermittent double vision [Fig. 1]. The prednisone daily dosage was increased to 25 mg. She was seen by neuro-ophthalmology 4 months after she had begun corticosteroid therapy, she was diagnosed with an abducens paresis, and a biopsy of the temporal artery was performed [Fig. 2]. It showed high-grade arteritis changes as well as multiple giant cells consistent with the acute stage of giant cell arteritis (GCA).

• References

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• 2 Espígol-Frigolé G, Prieto-González S, Alba MA. et al. Advances in the diagnosis of large vessel vasculitis. Rheum Dis Clin North Am 2015; 41: 125-140