Detaillierte Beitrags-Information
| Beitragstitel | CASE REPORT - Pain’s Clues: Precision Diagnosis by Taking a Comprehensive Medical History in Giant Cell Arteritis |
|---|---|
| Beitragscode | P26 |
| Autor:innen | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract-Text |
Background: Giant cell arteritis (GCA) necessitates prompt and accurate diagnosis to prevent severe complications. It typically presents with unilateral temporal headache, jaw claudication, vision loss, and elevated inflammatory markers. The diagnosis is confirmed by temporal artery biopsy. However, atypical presentations of GCA can complicate diagnosis and delay treatment. Case report: A 68-year-old Caucasian female presented to our emergency department with progressive visual symptoms. She experienced a brief blackout in her left eye ten days before. Clinically, she exhibited bilateral ocular movement restriction and mild left ptosis, with no other neurological deficits. Lab tests showed mildly elevated inflammatory markers and ESR, and prior brain imaging ruled out significant neurocranial conditions. As differential diagnoses myasthenia gravis, brainstem lesion and inflammatory causes were considered. Lumbar puncture and myasthenia antibody tests were normal; blood screening showed elevated anti-ANA and Anti-SS-A. A repeat cerebral MRI revealed faint contrast enhancement with slight edema in the retrobulbar adipose tissue bilaterally. After being specifically asked, the patient later reported recent bilateral temporal headaches and jaw claudication, that she had never associated with her current visual symptoms. A Doppler ultrasound examination revealed a partially positive compression test on the left superficial temporal artery, suggesting possible cranial arteritis, without any clear halo sign. Steroid therapy led to symptom stabilization after 5 days. A temporal artery biopsy on day 3 after treatment start confirmed GCA. The patient was discharged for outpatient follow-up and Tocilizumab treatment. Discussion: Atypical presentations can complicate GCA diagnosis; thus, a comprehensive medical history is essential, illustrated by our case. Our patient's initial mild headache, preceding her visual symptoms, was overlooked, demonstrating that GCA can manifest with diverse headache intensities, locations, and types. GCA should be considered in patients with oculomotor issues, although oculomotor nerve palsies are uncommon in GCA. In our case, ESR was unremarkable as GCA can present with normal ESR and CRP levels. Conclusion: Our case aims to raise awareness about the importance of detailed medical history and the need to suspect GCA in subtle headaches in patients over 60, to ensure prompt and appropriate diagnostic and treatment actions. |