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Washington University Experience | VASCULAR | Vasculitis - Giant Cell Arteritis | 6A0 Case 6 History
Case 6 History ---- The patient is an 83-year-old woman. The patient was in her usual state of health on 8/12 when she experienced relatively acute onset of difficulty seeing with her R eye in the upper portion of her field of vision presenting as blurry spots. The patient denies any headaches, scalp tenderness, difficulty combing her hair, or pain over her temples; however, over the past month, she has been diagnosed with thrush after developing pain in her tongue and cheeks that is exacerbated with chewing. She specifically denies any pain inside her mouth or pain with swallowing. She also visited an ENT physician who was concerned for Burning Mouth syndrome and started her on clonazepam 0.5mg but this has made her too sleepy so she has not been taking it. With regards to the vision loss, she denies any diplopia, eye pain, pain with eye movement, or sensation of something in her eye. She has no history of symptoms of polymyalgia rheumatica. However, on awakening yesterday morning, she noted that her entire field of vision in her R eye was gray and very blurry. She was noted to have significant visual field deficits and an afferent pupillary defect. ESR was 44. She also had a head CT which showed no acute intracranial process. She was given ASA 325 and transferred to Barnes ED for further evaluation. Ophthalmology evaluated the patient in the ED and found her to have marked vision loss in all quadrants in her R eye and grade 1-2 disc edema without disc hemorrhages on the right side. The patient had received IVMP 250mg prior to their evaluation given concern for temporal arteritis. Operative procedure: Left temporal artery biopsy.
