Journal des rapports de cas cliniques

A Case of Temporal Artery Dissection in a Patient with Giant Cell Arteritis

Abstract

Shubha Kollampare, Wendy Mackerricher, Dominick Sudano, Rafael Grau and Jeffrey Lisse

Giant cell arteritis (GCA) is a chronic vasculitis involving medium and large sized arteries. A 73-year-old male presented with right eye visual loss and jaw claudication associated with photosensitivity, supraorbital and retrobulbar pain. Evaluation demonstrated bitemporal tenderness, elevated ESR, CRP, leukocytosis and positive PANCA. Stranding and abnormal enhancement of right retrobulbar fat along the optic nerve sheath complexes was noted on MRI. Emergent biopsy of right temporal artery showed giant cell infiltration, disruption of internal elastic lamina with medial dissection. Despite steroid therapy, blurry vision in the left eye progressed to blindness. Tocilizumab infusion was initiated without much improvement. Interleukin 6 levels correlate with disease activity and severity in GCA. Glucocorticoids reduce inflammation by decreasing IL-6; however in refractory cases, the use of interleukin 6 antagonists may aid in rapid induction of remission. Blindness is a serious and irreversible complication of GCA, which makes early detection and treatment paramount.