Case history

Case history

A 72-year-old woman of Northern European ancestry presents with partial vision loss in the right eye. She reports bitemporal headache for several weeks, accompanied by pain and stiffness in the neck and shoulders. Review of systems is positive for low-grade fever, fatigue, and weight loss. On physical examination, there is tenderness of the scalp over the temporal areas and thickening of the temporal arteries. Fundoscopic examination reveals pallor of the right optic disc. Bilateral shoulder range of motion is limited and painful. There is no synovitis or tenderness of the peripheral joints. There are no carotid or subclavian bruits, and the blood pressure is normal and equal in both arms. The remainder of the examination is unremarkable.

Other presentations

Neurological manifestations can occur, though uncommonly, and may include stroke, transient ischaemic attack, or neuropathy.[2][3][4] Respiratory tract symptoms are uncommon but may include cough or sore throat. Rarely, dental pain, tongue pain, or infarction of the tongue may be present.[2][5] In addition, over 20% of patients who have symptoms suggestive of polymyalgia rheumatica may have GCA.[6] GCA can rarely present as an unexplained systemic illness or fever of unknown origin with elevated levels of inflammatory markers without headache, jaw claudication, shoulder or hip girdle stiffness, or visual disturbances.

Patients with large-vessel stenoses (approximately 10% to 15% of patients) may present with claudication of (usually) upper extremities, asymmetric blood pressures, or decreased pulses.[7] Rarely, involvement of lower extremity vessels results in leg claudication.[8]

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