giant cell arteritis manifested by bilateral arteritic anterior ishchemic optic neuropathy and jaw pain: a visually devastating condition
;Mrunal Kurangi; Ugam Usgaonkar
The Cochrane database of systematic reviews2015Vol. 04pp. 139-145
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kurangi2015journalgiant
Abstract
Giant Cell Arteritis (GCA) is a systemic vasculitis of
unknown etiology affecting medium and large calibre
vessels by granulomatous panarteritis with the
formation of giant multinucleate cell granulomas.
Vision is affected in 25-50% of GCA patients.
Affection of vision may be the first GCAsymptom or a
symptom which occurs weeks or months after the
initial symptoms of the disease. Permanent damage to
the patient's vision is a serious consequence of GCA.
Arteritic Anterior Ischaemic Optic Neuropathy
(AION) is the most frequent and most serious visual
manifestation of GCA. It is manifested by partial or
total loss of vision. Arteritic AION therapy in GCA
uses high doses ofglucocorticoids, but glucocorticoid
therapy has a number of adverse effects. The proofs of
the effect of the therapy on the improvement of the
vision of patients with visual affection in GCA are not
convincing. We report a case of a 55-year old female
with biopsy-verified GCA whose primary
manifestation was bilateral arteritic AION resulting in
a complete loss of vision in one eye and dramatic
worsening of visual acuity in the other eye. Even after
diagnosis glucocorticoid therapy could not salvage her
vision and led to secondary complications. This proves
that appropriate high dose glucocorticoid therapy does
not promise success of therapy in GCA. An increased
awareness of giant cell arteritis should lead to earlier
diagnosis and treatment and avoidance of the
devastating consequences.