WHEN THE PICTURE MASKS THE DIAGNOSIS - AN ATYPICAL AND SEVERE GIANT CELL ARTERITIS CASE REPORT.

Autor:	Moleiro AF; Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal; and.; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal., Vilares-Morgado R; Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal; and.; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal., Falcão-Reis F; Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal; and.; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal., Torres-Costa S; Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal; and.
Jazyk:	angličtina
Zdroj:	Retinal cases & brief reports [Retin Cases Brief Rep] 2024 Jul 01; Vol. 18 (4), pp. 446-450.
DOI:	10.1097/ICB.0000000000001409
Abstrakt:	Purpose: The purpose of this study was to describe an atypical and severe case of giant cell arteritis (GCA). Methods: This was a case report description. Results: The authors report the case of a 76-year-old man who presented with severe and progressive bilateral visual loss. On presentation at the ophthalmology emergency room, the patient's right eye (OD) displayed aqueous flare, hyphema, rubeosis iridis , and dense posterior capsular opacification. After YAG laser capsulotomy, vitreous densifications, intraretinal hemorrhages, cotton wool spots, retinal ischemia, and vasculitis were observed in the fundoscopy. The patient's left eye (OS) also presented intraretinal hemorrhages and cotton wool spots around the temporal arcades. The diagnostic workup excluded infectious diseases, demyelinating diseases, and ocular ischemic syndrome due to carotid obstruction. Proteinogram revealed a monoclonal gammopathy, suggesting a possible hematologic condition. High-dose corticotherapy was initiated, which improved the vitreous densifications and enabled the visualization of the pale optic disk. The remaining study did not confirm the diagnosis of hematologic disease. During follow-up, bilateral VA deteriorated, with the development of progressive pallor in the OS optic disk. Follow-up fluorescein angiography demonstrated progressive retinal and choroidal ischemia. Finally, owing to high clinical suspicion, temporal artery Doppler ultrasound was performed, confirming the diagnosis of GCA. Conclusion: GCA may present multiple ocular features. The knowledge of these different presentations, including retinal and choroidal ischemia or uveitis, is critical for timely diagnosis and treatment initiation. Since patients with GCA often present with vision loss, ophthalmologists may be the first medical doctors who contact with these patients, being on the frontline of GCA diagnosis. Competing Interests: Conflict of interest statement: The authors have no financial disclosure to declare. This work did not receive any grants or funds support. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)
Databáze:	MEDLINE
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