Granulomatosis with polyangiitis masquerading as giant cell arteritis
A 65-year-old man presented with headache, weight loss, occasional scalp tenderness, and visual loss in his left eye, which worsened over a number of weeks to bare light perception. There was a left relative afferent papillary defect with a swollen disc and a small amount of associated hemorrhage. Erythrocyte sedimentation rate (ESR) was 16 mm/1st h, C-reactive protein (CRP) was 3.3 mg/l (normal <7). Temporal artery biopsy demonstrated no evidence of arteritis. On initiation of corticosteroids, his vision improved dramatically and the corticosteroids were subsequently weaned to zero over a period of 6–8 weeks.
Three months later, he re-presented with left-sided ptosis and worsening headache. There had been weight loss (7 kg within the prior 6 months). Examination revealed a complete left-sided ptosis, with normal eye movements. Visual acuity was measured at 6/5−2 on the right and 6/9−2 on the left. Slit-lamp examination was unremarkable.
KeywordsMycophenolate Mofetil Giant Cell Arteritis Temporal Artery Biopsy Hypertrophic Pachymeningitis Meningeal Involvement
Conflicts of interest
The patient gave his informed consent for this publication.