A case of giant cell arteritis presenting with nodular poste
Giant cell arteritis (GCA), also known as temporal arteritis, is a common systemic vasculitis of medium- and large-sized arteries in patients aged over 50 years with a wide spectrum of clinical manifestations. It is a true ophthalmic emergency—a delay in treatment may result in permanent and bilateral vision loss from ischemic complications.

A 67-year-old man presented with sudden onset left-sided periorbital pain, blurry vision, and a choroidal lesion in the posterior pole. Despite treatment with high-dose oral prednisone for suspected nodular posterior scleritis mimicking a choroidal mass, the vision in his left eye did not recover, and he developed optic nerve pallor on exam. Further evaluation revealed an ESR of >140 mm/hr , a CRP of 113 mg/L , and a temporal artery biopsy consistent with GCA. The patient was started on methotrexate and the oral steroids were slowly tapered.

Conclusively, the potential for GCA to present with scleritis and the potential for nodular posterior scleritis to mimic a choroidal mass, presence of a painful choroidal lesion with optic nerve swelling should prompt an evaluation for GCA to prevent permanent and bilateral vision loss.

Source: https://www.sciencedirect.com/science/article/pii/S2451993619302373
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