Abstract
A 76-year old African American female with a history of arteritic ischemic optic neuropathy (AION) secondary to biopsy-proven giant cell arteritis (GCA) presented with unilateral vision loss in her contralateral eye despite high-dose oral steroid treatment. Dilated fundus examination revealed three cotton wool spots. Fluorescein angiography showed slowed arteriolar filling with late staining of small peripheral arteries, consistent with small vessel arteritis. Laboratory tests for alternative vasculitides were negative. Review of her temporal artery biopsy specimen confirmed lymphoplasmacytic inflammation around small adventitial vessels with no destructive granulomatous or leukocytoclastic small vessel vasculitis, consistent with GCA. Our unique case demonstrates peripheral small vessel retinal arteriolar leakage in GCA, which is a rare finding. This association is of interest because GCA is commonly associated with medium to large vessel pathology without small vessel involvement.
Highlights
A 76-year old African American female with a history of arteritic ischemic optic neuropathy (AION) secondary to biopsy-proven giant cell arteritis (GCA) presented with unilateral vision loss in her contralateral eye despite highdose oral steroid treatment
Uncorrected visual acuity was decreased from her baseline of 20/40 to 20/70 in the right eye with no improvement with pinhole
Workup for other causes of small vessel vasculitis, including anti-neutrophil cytoplasmic antibodies (ANCA), antinuclear antibodies (ANA), lyme and syphilis serologies, was negative. Review of her medications failed to demonstrate any known pharmaceuticals associated with retinal vasculitis or intraocular inflammation
Summary
A 76-year old African American female with a history of arteritic ischemic optic neuropathy (AION) secondary to biopsy-proven giant cell arteritis (GCA) presented with unilateral vision loss in her contralateral eye despite highdose oral steroid treatment. Presentation A 76-year-old woman with a history of hypertension, non-insulin dependent type 2 diabetes, stroke, and arteritic ischemic optic neuropathy (AION) of the left eye due to biopsy-proven giant cell arteritis (GCA) presented with painless, diffuse vision loss in the right eye for the past 10 days despite current high-dose oral steroid treatment (0.75 mg/kg/day prednisone). Dilated fundus examination showed two cotton wool spots in the right eye (Fig. 1a), which had not been noted
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