Thursday, July 7, 2016

Scandinavia II

A 77 year old woman of Scandinavian descent presents with subacute fever, fatigue, and weight loss. She has been undergoing a workup for fever of unknown origin. She is finally referred to a neurologist because of a new headache. The characteristics of the headache, though, are nonspecific. She also has some jaw claudication with a rapid onset of pain once she starts chewing. Still, no diagnosis is made until she presents to the emergency room with transient monocular visual loss. There was a temporary partial field cut that returned when she was in the ER. The ophthalmologic exam was unremarkable.

Challenge: You better make the diagnosis before she has permanent visual loss; what is this?

Image shown under Fair Use.


RaH said...

Morbus Horton / temporal arteritis!
high dose steroids are in order... diagnosis can be made with ultrasound (Halo sing visible) of the temporal artery and 2 separate biopsie of the artery.

Anonymous said...

GCA. Associated with PMR. It's a large vessel vasculitis. Could check a sed rate and/or hsCRP. It can lead to permanent vision loss. If suspected start on high dose systemic steroids while waiting for the bx to return! I believe they are on a steroid taper for a long long time after.

Craig Chen said...

good job! i've only diagnosed this once, but it's an important catch
Scandinavia II

This is giant cell arteritis, a vasculitis of large- and medium-sized vessels. The image shows thickened and tender temporal cranial arteries.

Source: UpToDate.