Fu Lanxing, O'Sullivan Eoin P
Ophthalmology, King's College Hospital, London, GBR.
Cureus. 2022 Oct 1;14(10):e29804. doi: 10.7759/cureus.29804. eCollection 2022 Oct.
An 81-year-old Afro-Caribbean woman presented with a two-week history of a dull headache in her temples, jaw claudication especially when chewing food, and reduced vision in her eyes, more pronounced in the right eye. There was no past medical or family history of hypothyroidism or autoimmunity. On examination, the vision was counting fingers in the right eye and 6/36 in the left eye, best corrected. Dilated fundus examination revealed multiple peripapillary cotton wool spots in both eyes though more pronounced in the right. Her erythrocyte sedimentation rate (ESR) was 120 mm/h, and her C-reactive protein (CRP) level was 79 mg/L. A temporal artery ultrasound scan was undertaken immediately which demonstrated a halo sign around both temporal arteries and so a giant cell arteritis (GCA) diagnosis was made. The patient was commenced on daily high-dose IV methylprednisolone 1 g for three days and referred to the rheumatology team. Her vision improved to 1/60 right and 6/9 left eye best corrected at three days post-treatment. At 12 months after the initial presentation, her vision stabilized at 6/60 in the right and 6/6 with complete visual fields in the left eye. Cotton wool spots can be a sign of GCA. Their appearance with or without characteristic systemic symptoms should prompt urgent evaluation.
一名81岁的非洲加勒比裔女性，出现双侧颞部钝痛两周，伴有咀嚼食物时的颌部跛行，以及视力下降，右眼更为明显。既往无甲状腺功能减退或自身免疫性疾病的病史及家族史。检查时，右眼视力为眼前指数，左眼最佳矫正视力为6/36。散瞳眼底检查发现双眼视乳头周围有多个棉絮斑，右眼更为明显。她的红细胞沉降率（ESR）为120mm/h，C反应蛋白（CRP）水平为79mg/L。立即进行了颞动脉超声扫描，结果显示双侧颞动脉周围有晕征，因此诊断为巨细胞动脉炎（GCA）。患者开始接受每日1g大剂量静脉注射甲基强的松龙治疗，为期三天，并转诊至风湿科团队。治疗三天后，她的右眼最佳矫正视力提高到1/60，左眼为6/9。初次就诊12个月后，她的右眼视力稳定在6/60，左眼视力为6/6，视野完整。棉絮斑可能是GCA的一个体征。无论有无典型的全身症状，其出现都应促使进行紧急评估。
