A patient presents with fever, fatigue, temporal scalp tenderness, and sudden vision loss. Suspect which condition?

A patient presents with fever, fatigue, temporal scalp tenderness, and sudden vision loss. Suspect which condition?

• A. Giant cell arteritis
• B. Takayasu arteritis
• C. Kawasaki disease
• D. Polyarteritis nodosa

Answer: (A)

This presentation points to giant cell arteritis, a granulomatous vasculitis of medium-to-large arteries that almost always affects people over 50. The combination of fever, fatigue, and especially temporal scalp tenderness signals activity in the superficial temporal arteries. The sudden vision loss occurs when inflammation involves arteries supplying the optic nerve, leading to ischemia of the retina or optic nerve—an emergency because prompt treatment can prevent permanent blindness. Key features here are age over 50, new temporal-area tenderness, systemic symptoms, and visual disturbance. Lab tests typically show elevated inflammatory markers, and confirmation is by temporal artery biopsy showing granulomatous inflammation with multinucleated giant cells and damage to the vessel wall. Importantly, treatment should start right away with high-dose corticosteroids to protect vision, even before biopsy results. Other vasculitides don’t fit as well: Takayasu arteritis usually affects younger patients and presents with pulses and limb claudication changes; Kawasaki disease is a pediatric condition with mucocutaneous findings; polyarteritis nodosa involves medium-sized arteries but lacks the classic temporal tenderness and the acute, sight-threatening optic ischemia seen here.

This presentation points to giant cell arteritis, a granulomatous vasculitis of medium-to-large arteries that almost always affects people over 50. The combination of fever, fatigue, and especially temporal scalp tenderness signals activity in the superficial temporal arteries. The sudden vision loss occurs when inflammation involves arteries supplying the optic nerve, leading to ischemia of the retina or optic nerve—an emergency because prompt treatment can prevent permanent blindness.

Key features here are age over 50, new temporal-area tenderness, systemic symptoms, and visual disturbance. Lab tests typically show elevated inflammatory markers, and confirmation is by temporal artery biopsy showing granulomatous inflammation with multinucleated giant cells and damage to the vessel wall. Importantly, treatment should start right away with high-dose corticosteroids to protect vision, even before biopsy results.

Other vasculitides don’t fit as well: Takayasu arteritis usually affects younger patients and presents with pulses and limb claudication changes; Kawasaki disease is a pediatric condition with mucocutaneous findings; polyarteritis nodosa involves medium-sized arteries but lacks the classic temporal tenderness and the acute, sight-threatening optic ischemia seen here.