Use of Noninvasive Imaging in Giant Cell Arteritis

Posterior Uveitis Associated with Large Vessel Giant Cell Arteritis

PURPOSE

To report a case of acute unilateral posterior uveitis as a rare manifestation of giant cell arteritis (GCA).

OBSERVATION

A 62-year-old male presented to the clinic for evaluation of decreased vision in the right eye (OD). BCVA in OD was 20/60, and fundus examination revealed 3+ vitreous cells along with several inflammatory precipitates located in posterior vitreous and on surface of retina. Although TAB was inconclusive for GCA, the clinical diagnosis of GCA was made according to the GCA diagnostic criteria. This diagnosis was further supported by 18FDG-PET scan. The patient was started on corticosteroids, and the symptoms improved significantly after first week of treatment. At follow-up visit one month and half later, BCVA improved to 20/40 in the right eye.

CONCLUSION

Although GCA is rarely present with uveitis, in case of unilateral posterior uveitis in elderly patient, it should be considered in the differential diagnosis.

Giant cell arteritis: A case report and review of literature

Giant cell arteritis, the most common form of vasculitis in the elderly, is characterized by granulomatous inflammation of arteries, which can lead to serious, life-threatening conditions including aortic aneurysms, ruptures, and dissections as well as blindness. Since GCA can be treated by immunosuppressant therapy, such as corticosteroids, early diagnosis and treatment may reduce the risk of serious disability and morbidity. While temporal artery biopsy is considered the gold standard to diagnosis giant cell arteritis, it is intrusive with inherent risks as well as unreliable due to tissue sampling. Imaging studies, such as computerized tomography, are nonintrusive and have been shown to identify vasculitis including giant cell arteritis. We present a case of a 72-year-old male patient who was diagnosed with giant cell arteritis by temporal artery biopsy during surgery for aortic aneurysm and coronary artery bypass graft. Computerized tomography imaging studies, prior to the surgery and biopsy, were suggestive of vasculitis. This case serves to emphasize the beneficial role of imaging studies to assess vasculitis, including giant cell arteritis, that can be done prior to the progressive development of more serious debilitating and potentially fatal pathology.