giant cell arteritis manifested by bilateral arteritic anterior ishchemic optic neuropathy and jaw pain: a visually devastating condition

Giant Cell Arteritis (GCA) is a systemic vasculitis of unknown etiology affecting medium and large calibre vessels by granulomatous panarteritis with the formation of giant multinucleate cell granulomas. Vision is affected in 25-50% of GCA patients. Affection of vision may be the first GCAsymptom or a symptom which occurs weeks or months after the initial symptoms of the disease. Permanent damage to the patient's vision is a serious consequence of GCA. Arteritic Anterior Ischaemic Optic Neuropathy (AION) is the most frequent and most serious visual manifestation of GCA. It is manifested by partial or total loss of vision. Arteritic AION therapy in GCA uses high doses ofglucocorticoids, but glucocorticoid therapy has a number of adverse effects. The proofs of the effect of the therapy on the improvement of the vision of patients with visual affection in GCA are not convincing. We report a case of a 55-year old female with biopsy-verified GCA whose primary manifestation was bilateral arteritic AION resulting in a complete loss of vision in one eye and dramatic worsening of visual acuity in the other eye. Even after diagnosis glucocorticoid therapy could not salvage her vision and led to secondary complications. This proves that appropriate high dose glucocorticoid therapy does not promise success of therapy in GCA. An increased awareness of giant cell arteritis should lead to earlier diagnosis and treatment and avoidance of the devastating consequences.