Giant cell arteritis presenting as bilateral anterior ischemic optic neuropathy: a biopsy-proven case report in Chinese patient

Abstract

BackgroundGiant cell arteritis (GCA) is a systemic vasculitis of medium and large-size vessels and can led to permanent visual loss in elderly patients. GCA is very rare among Asians. We report a Chinese patient presenting with acute bilateral anterior ischemic optic neuropathy, and the temporal artery biopsy proved the diagnose of GCA.Case presentationA 77-year-old Chinese man presented with sudden bilateral blindness for 5 days with a severe headache. Funduscopic examination revealed bilateral optic disc swollen with “chalky white” pallid appearance. The blood tests showed the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) elevated dramatically. The color duplex ultrasonography (CDUS) of the superficial temporal artery revealed the inflammation of the vessel wall as a “halo sign”. The temporal artery biopsy was perfumed and the pathology revealed luminal occlusion with multinuclear giant cell infiltration. The patient was treated with intravenous methylprednisolone for 3 days and oral prednisone weaning for 12 months. The visual acuity remained no light perception at one year follow-up.ConclusionsAlthough very rare in Asian, GCA can led to permanent blindness in elderly Chinese caused by anterior ischemic optic neuropathy. The noninvasive CDUS might be a promising technique for diagnose GCA in highly suspected patients.

Giant cell arteritis: Its ophthalmic manifestations

“…GCA is far more common among Caucasians than other races; however, it is reported among non-Caucasians all over the world, e.g., from China[ 7 8 9 10 ], Taiwan[ 11 ], Korea[ 12 ], Japan[ 13 ], Thailand[ 14 15 ], Malaysia[ 16 ], Israel[ 17 ], Arabs[ 18 ], Mexicans[ 19 ], African American[ 20 21 ], and Alaskan Natives. [ 22 ] There are several reports of variable numbers of patients of GCA from India, including from the Punjab[ 23 24 25 26 ], New Delhi[ 27 ], Mumbai[ 28 ], Goa[ 29 ], South India[ 30 31 32 33 34 35 ], and Assam.…”

Giant Cell Arteritis Presenting as Unilateral Arteritic Anterior Ischemic Optic Neuropathy

“…Normal values of these data in the context of low clinical suspicion are enough to safely rule out GCA and TAB is not necessary in these cases [10][11]. The visual prognosis is extremely unfavorable in acute unilateral arteritic-AION, and the visual outcome did not improve in the patients in other studies [12][13][14].…”

Giant Cell Arteritis Presenting With Ocular Symptoms: Clinical Characteristics and Multimodal Imaging in a Chinese Case Series

“…The incidence of GCA in Asians is 20 times less than that in Caucasians ( 1 ). Although rare, an increasing number of Asian GCA cases, with typical clinical features that are commonly observed among Caucasians, has been reported ( 2 – 6 ); however, only one nationwide survey has addressed that the prevalence of GCA in patients aged > 50 years in 1997 was 1.47 per 100,000 persons in Japan ( 7 ).…”

“…In 2018, we reported the case of a Chinese patient with biopsy-proven GCA, presenting with simultaneous anterior ischemic optic neuropathy (AION) with no light perception ( 6 ). To our knowledge, this is the first Chinese case report on the ophthalmic involvement in this disease.…”