Singh Ruchir, Sahbudin Ilfita, Filer Andrew
Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
BMJ Case Rep. 2018 Jun 27;2018:bcr-2017-223240. doi: 10.1136/bcr-2017-223240.
An 80-year-old man presented repeatedly to his general practitioner with 3 months of unexplained persistent frontal headaches. CT head revealed no diagnosis. His dentist diagnosed his co-existing jaw pain as bruxism. Three months later, the patient happened to attend a routine ophthalmology follow-up appointment. During this routine appointment, features of giant cell arteritis (GCA) including worrying visual complications were first noted. His inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) were not significantly raised-contrary to the norm. A temporal artery ultrasound and biopsy were performed, in light of the history. This confirmed GCA. He was commenced on high-dose oral prednisolone and was managed by ophthalmology and rheumatology. At 4 weeks, symptoms resolved with no permanent visual loss despite a prolonged initial symptomatic period. Multiple symptomatic presentations to different specialties should therefore alert clinicians to a unifying diagnosis, for example, vasculitis. Serious illnesses may present with severe symptoms despite normal screening investigations.
一名80岁男性因3个月原因不明的持续性前额头痛反复就诊于他的全科医生。头颅CT检查未明确诊断。他的牙医将其同时存在的颌部疼痛诊断为磨牙症。3个月后，患者偶然参加了一次常规眼科复诊。在这次常规复诊中，首次发现了巨细胞动脉炎（GCA）的特征，包括令人担忧的视力并发症。他的炎症指标（C反应蛋白和红细胞沉降率）并未显著升高——与正常情况相反。鉴于病史，进行了颞动脉超声检查和活检。这证实了GCA的诊断。他开始服用大剂量口服泼尼松龙，并由眼科和风湿科进行治疗。4周时，尽管最初有较长时间的症状期，但症状得到缓解，未出现永久性视力丧失。因此，向不同专科的多次症状性就诊应提醒临床医生注意统一的诊断，例如血管炎。尽管筛查检查结果正常，但严重疾病可能会出现严重症状。
