Premium
Recognition of giant cell arteritis in patients with polymyalgia rheumatica who have a stroke: a cautionary tale
Author(s) -
Gutteridge Donald H.,
Mastaglia Frank L.
Publication year - 2017
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13567
Subject(s) - medicine , polymyalgia rheumatica , giant cell arteritis , arteritis , stroke (engine) , dermatology , vasculitis , disease , mechanical engineering , engineering
An 82‐year‐old woman with polymyalgia rheumatica ( PMR ) on prednisone 7 mg daily was admitted to an acute stroke unit with a right homonymous hemianopia, a left posterior cerebral artery occlusion and occipital lobe infarct. She had raised inflammatory markers, did not have a temporal artery biopsy, and was discharged on the same dose of prednisone. After 21 months, off prednisone, her ophthalmologist, concerned about giant cell arteritis ( GCA ), restarted prednisone 40 mg daily, with rapid, profound visual improvement. After 3 days her general practitioner, noting normal baseline inflammatory markers, stopped treatment‐with rapid visual reversion. It is critical to recognise GCA in patients with PMR admitted to a stroke unit and not to withdraw prematurely corticosteroids once commenced.