Korean J Ophthalmol.  2013 Jun;27(3):224-227. 10.3341/kjo.2013.27.3.224.

Silent Giant Cell Arteritis in an Elderly Korean Woman

• Cha DM
• Lee T
• Choe G
• Yang HK
• Hwang JM

• KMID: 1798064
• DOI: http://doi.org/10.3341/kjo.2013.27.3.224

Abstract

Giant cell arteritis (GCA) is a rare disease among Asians. Arteritic anterior ischemic optic neuropathy, which accompanies GCA, has not yet been reported in Koreans. Diagnosis of GCA is difficult if typical symptoms other than visual loss are absent. Here, we report a case of an 83-year-old Korean woman presenting with sudden visual loss in both eyes (oculus uterque, OU). Her visual acuities included perception of light in the right eye (oculus dexter, OD) and perception of hand motion in the left eye (oculus sinister, OS). The results of the Hardy-Rand-Rittler test and Ishihara test showed total dyschromatopsia OU. The Goldmann perimetry test revealed a total field defect OD and paracentral island OS. Fundus examination revealed chalky-white disc swelling OU. Other systemic symptoms and signs were unremarkable. The erythrocyte sedimentation rate, C-reactive protein and platelet count were highly elevated. Temporal artery biopsy revealed multiple lymphocytes and multinucleated giant cells in the arterial media layer. To our knowledge, this is the first report of GCA in a Korean that has been confirmed with temporal artery biopsy. In conclusion, silent GCA can occur in Koreans, and hence, elderly patients presenting with chalky-white disc swelling, and corresponding laboratory findings must be evaluated for GCA.

Keyword

Giant cell arteritis; Ischemic optic neuropathy; Silent giant cell arteritis

MeSH Terms

Aged, 80 and over
*Asian Continental Ancestry Group
Female
Giant Cell Arteritis/complications/*diagnosis
Humans
Optic Neuropathy, Ischemic/*diagnosis/etiology
Vision Disorders/*diagnosis/etiology

Figure

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  Fig. 1 Fundoscopic findings. Chalky-white disc swellings were found in both eyes (A, right eye; B, left eye), especially in the right eye (A).

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  Fig. 2 Histopathology of left temporal arterial biopsy. (A) Diffuse infiltration by multiple inflammatory cells including lymphocytes, macrophages and multinucleated giant cells into all layers of the arterial wall, especially the media (H&E, ×100). (B) A few multinucleated giant cells among the diffusely infiltrated lymphocytes (H&E, ×400).

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