Martis Anoka, Hassan Romesa Sajjad, Alburquerque Ana Goico, Kotte Manasa, Martis Anshu, Ahmed Hassan
Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.
Rheumatology, University of Illinois at Chicago, Chicago, IL 60612, USA.
Oxf Med Case Reports. 2020 Nov 24;2020(11):omaa099. doi: 10.1093/omcr/omaa099. eCollection 2020 Nov.
Giant cell arteritis (GCA) or temporal arteritis is a granulomatous vasculitis that affects medium-to-large vessels seen primarily in older Caucasian populations. Here, we describe a 67-year-old male who presented with atypical symptoms of worsening headaches associated with left-sided pupil-sparing, isolated third nerve palsy, blurry vision, diplopia and myalgias in bilateral extremities. He was immediately started on intravenous Methylprednisolone for suspected GCA. Subsequent biopsy of the temporal arteries showed panarteritis without giant cells and disruption of the internal elastic lamina. His symptoms improved in a day following treatment and he was discharged on a Prednisone taper. At the time of writing this case, there are only two cases in the literature of ptosis as a presenting symptom in GCA, thus highlighting the importance of recognizing rare red flag symptoms such as ptosis and diplopia. More study is needed in the prognostic significance of these unusual clinical features.
巨细胞动脉炎（GCA）或颞动脉炎是一种肉芽肿性血管炎，主要影响中老年白种人群中的中到大血管。在此，我们描述一名67岁男性，他表现出非典型症状，包括头痛加重，伴有左侧瞳孔保留、孤立性动眼神经麻痹、视力模糊、复视以及双侧肢体肌痛。因怀疑患有GCA，他立即开始接受静脉注射甲泼尼龙治疗。随后颞动脉活检显示全动脉炎，无巨细胞，内弹性膜破坏。治疗一天后他的症状有所改善，并在逐渐减量的泼尼松治疗下出院。在撰写本病例时，文献中仅有两例以眼睑下垂作为GCA首发症状的病例，因此凸显了识别诸如眼睑下垂和复视等罕见警示症状的重要性。对于这些不寻常临床特征的预后意义，还需要更多研究。
