Giant cell arteritis with normal inflammatory markers

Abstract

a positive temporal artery biopsy, which is diagnostic of GCA. In clinical practice, both tests are performed to evaluate for GCA. 7 This case is unusual as, at the time of presentation, the inflammatory markers were low to normal. Furthermore, the patient did not exhibit the classical symptoms of headache, scalp tenderness, jaw claudication or PMR-related symptoms. Rather, the patient presented directly with visual loss.Notable learning points drawn from this case are that normal inflammatory markers should not exclude the diagnosis of GCA. If suspicion remains high, inflammatory markers should be repeated. It should also be noted that GCA may not present with the typical symptoms of headache, temporal tenderness or jaw claudication; instead, it may present directly with visual symptoms.Early treatment with steroids is essential to prevent progression of visual symptoms and to protect the contralateral eye. 8