Giant cell arteritis mimicking infiltrative leptomeningeal disease of the optic nerves

Michael Kornberg, John N. Ratchford, Rathan M. Subramaniam, John C Probasco

Research output: Contribution to journalArticle

Abstract

A 67-year-old man presented with several days of progressive, painless left eye vision loss. He reported mild jaw claudication but denied headache, scalp tenderness or constitutional symptoms. Examination revealed palpable temporal arteries, blurring of the left optic disc, and 20/100 vision in the left eye with mild relative afferent pupillary defect. Inflammatory markers were sent, and methylprednisolone was initiated for presumptive giant cell arteritis (GCA). Erythrocyte sedimentation rate was normal, however, and C reactive protein was only mildly elevated, prompting further investigation. Orbital MRI revealed nodular enhancement of the optic nerve sheaths bilaterally from optic nerve head to chiasm, raising concern for an infiltrative leptomeningeal process such as sarcoidosis or lymphoma. Methylprednisolone was temporarily stopped while a broad work up for inflammatory and neoplastic causes was pursued. Fluorodeoxyglucose-positron emission tomography ultimately revealed hypermetabolism in the temporal, ophthalmic and occipital arteries suggesting GCA, which was confirmed by temporal artery biopsy. Steroids were restarted, and the patient's vision stabilised.

Original languageEnglish (US)
Article number209160
JournalBMJ Case Reports
Volume2015
DOIs
StatePublished - Apr 9 2015

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Optic Nerve Diseases
Giant Cell Arteritis
Temporal Arteries
Optic Disk
Methylprednisolone
Pupil Disorders
Ophthalmic Artery
Blood Sedimentation
Sarcoidosis
Optic Nerve
Jaw
Scalp
Positron-Emission Tomography
C-Reactive Protein
Headache
Lymphoma
Steroids
Biopsy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Giant cell arteritis mimicking infiltrative leptomeningeal disease of the optic nerves. / Kornberg, Michael; Ratchford, John N.; Subramaniam, Rathan M.; Probasco, John C.

In: BMJ Case Reports, Vol. 2015, 209160, 09.04.2015.

Research output: Contribution to journalArticle

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