Abstract
We report a rare case of association of temporal arteritis with recurrent central corneal ulcer. A 91-year-old male with a remote history of clinically diagnosed giant cell arteritis (GCA) and penetrating keratoplasty (PK) for corneal edema in 1990’s in the left eye presented with irritation and severe dry eye. He progressively developed central corneal ulcer regardless of treatment with aggressive lubrication and patching. The clinical course, blood tests and temporal artery biopsy results yielded the diagnosis of recurrent GCA. The clinical course improved after starting oral steroids. The case report illustrates the importance of ruling out GCA in patients with recurrent corneal ulcers and history of GCA. It also highlights the significance of shared understanding between primary care physicians and specialists to handle common and chronic diseases to make efficient diagnoses and plan treatment regimens. This is the first plausible case of reported GCA association with central corneal ulcer in the United States.
Highlights
Giant cell arteritis is a vasculitis of medium and large size arteries, predominantly involving the carotid artery system extending to the temporal artery and branches of the ophthalmic artery
At one-month follow-up, prednisone was tapered to 10 mg maintenance dose as patient had clinically improved with visual acuity 20/400
The clinical criteria established by the American College of Rheumatology (ACR) for diagnosis of giant cell arteritis (GCA) is: 1) age ≥ 50 years, 2) new onset localized headaches, 3) temporal artery tenderness or decreased temporal artery pulse, 4) ESR ≥ 50 mm/h and 5) superficial temporal artery biopsy (TAB) consistent with GCA [9]
Summary
Giant cell arteritis is a vasculitis of medium and large size arteries, predominantly involving the carotid artery system extending to the temporal artery and branches of the ophthalmic artery. The classic symptoms include headache, scalp tenderness, tongue and jaw claudication, and loss of vision. In literature, the presentation of GCA with unusual anterior segment signs, such as limbal guttering [5], scleritis [6], corneal edema [7] and peripheral ulcerative keratitis (PUK) [8], have been reported but not recurrent central corneal ulcer. We document here such a case in a patient with GCA
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