SHM Converge Scientific Abstract ePoster Gallery-Do Not Be Blinded by This Mortal Among Giants - An Atypical Presentation of Giant Cell Arteritis

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This case report describes an atypical presentation of giant cell arteritis (GCA) in a 62-year-old man with multiple comorbidities, including hypertension, coronary artery disease, atrial fibrillation, type 1 diabetes, and prior pancreatic/renal transplant on immunosuppression. He presented to the emergency department with severe headache, confusion, agitation, and visual difficulty. Because of his delirium and inability to cooperate, the diagnosis was initially unclear.<br /><br />He had a 6-day history of headache, neck pain, and shoulder pain and had been discharged from another facility with muscle relaxants. On exam, he was somnolent, hypertensive, and had neck rigidity and right-sided visual impairment. Extensive evaluation, including CT and MRI of the head and neck, lumbar puncture, and infectious, autoimmune, and metabolic testing, was unrevealing. Empiric antibiotics and antivirals were started but later stopped after negative cerebrospinal fluid studies.<br /><br />As his course evolved, he reported intermittent vision loss and marked tenderness over the right temporal and cervical regions. His inflammatory marker CRP was elevated at 17 mg/dL, raising concern for GCA. He was started on intravenous methylprednisolone, which led to rapid improvement in headache, confusion, and visual symptoms. He was discharged on oral prednisone with plans for outpatient temporal artery biopsy.<br /><br />The report emphasizes that delirium and cognitive changes can be part of GCA in older adults, making diagnosis difficult and potentially delaying treatment. Because permanent visual loss can occur in a significant proportion of patients, clinicians should consider GCA even when presentation is dominated by confusion or agitation. Early steroid therapy is critical to prevent complications.

Asset Subtitle

Tai Do

Meta Tag

Author List Tai Do, Usha Anand, Yasmin Rosshandler

Category Clinical Vignettes

Concept Giant Cell Arteritis

Concept Corticosteroids

Concept Headache

Concept Jaw Claudication

Concept Visual Symptoms

Distinguished Non-Finalist

Presenter Organization WellStar Kennestone RMC

Presenting Author Tai Do

Track Adult

Keywords

giant cell arteritis

GCA

delirium

visual loss

headache

temporal artery biopsy

corticosteroid therapy

confusion

inflammation marker CRP

older adults

Giant Cell Arteritis

Corticosteroids

Headache

Jaw Claudication

Visual Symptoms