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Case report.
An 80-year-old white hypertensive man presented with subacute visual loss in his right eye. He had a previous episode of left-sided visual loss 1 month earlier that had been attributed to anterior ischemic optic neuropathy, for which he was treated conservatively and was not given corticosteroids. During this current episode the visual disturbance was associated with weight loss and fatigue. Temporal artery pulsation was reduced, but there was no local tenderness; funduscopy showed central retinal vein occlusion. Erythrocyte sedimentation rate was 130 mm/h, and hemoglobin was 7.8 g/dL. Systemic steroid therapy was begun in view of the clinical suspicion of temporal arteritis. Color duplex sonography showed marked mural thickening and perimural edema of the right temporal artery (figure, A, B). Biopsy of the artery revealed marked intimal fibrosis with a mononuclear inflammatory cell infiltrate in the muscular wall and adventitia (figure, C). Despite high-dose steroids the patient was left with residual visual loss.
Figure. (A) Sonogram of right (affected) temporal fossa (longitudinal section) showing arteritis of temporal artery. There is marked thickening of the wall of the …
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