Giant Cell Arteritis in Ophthalmology Practice: a Case Report
https://doi.org/10.18008/1816-5095-2019-1-109-114
Abstract
Introduction. Giant cell (temporal) arteritis refers to a group of chronic and acute systemic vasculitis mainly affecting the extracranial and intracranial arteries of large and medium caliber. Loss of vision due to anterior ischemic optic neuropathy (AION) or occlusion of the central retinal artery is one of the most severe and most common complications of giant cell arteritis. This case report describes a patient with giant cell arteritis, the outcome of it was a total vision loss in the right eye. The patient repeatedly visited the ophthalmologists in the outpatient clinics with complaints of intermittent episodes of vision loss. Purpose. To present methods of diagnosis and treatment, through which the doctor at the initial reception will be able to suspect the disease and start treatment timely. Conclusions. The anamnestic criteria for the GCA diagnosis in the practice of ophthalmologist are: female, age over 50 years, headaches with paresthesia, intermittent lameness of the mandible, short-term episodes of vision loss. The necessary laboratory methods of research include: clinical blood test with determination of erythrocyte sedimentation rate, determination of C-reactive protein level.
About the Authors
V. A. Chernukha
Academy of postgraduate education under FSBU FSCC of FMBA of Russia
Russian Federation
Russian Federation
doctor-resident
Volokolamskoye highway, 91, Moscow, 125371, Russia
D. S. Atarschikov
The Central Clinical Hospital of the Presidential Administration of the Russian Federation
Academy of postgraduate education under FSBU FSCC of FMBA of Russia
Russian Federation
Russian Federation
PhD ophthalmologist
Marshal Timoshenko str., 15, Moscow, 121359, Russia
Volokolamskoye highway, 91, Moscow, 125371, Russia
N. V. Khamnagdaeva
The Central Clinical Hospital of the Presidential Administration of the Russian Federation
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
PhD, senior lecturer of the Department of pathophysiology and clinical pathophysiology, ophthalmologist
Marshal Timoshenko str., 15, Moscow, 121359, Russia
Ostrovityanov str., 1, Moscow, 117997, Russia
I. V. Pozharov
Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
PhD rheumatologist
Head of Rheumatology Department
Shchepkina st. 61/2, building 1, Moscow, 129110 Russian Federation
References
1. Dasgupta B., Borg F.A., Hassan N., et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology (Oxford). 2010;49(8):1594–1597. DOI: 10.1093/rheumatology/keq039a
2. Nesher G. The diagnosis and classification of giant cell arteritis. J Autoimmun. 2014 Feb-Mar;48–49:73–75. DOI: 10.1016/j.jaut.2014.01.017
3. Alvarez-Lafuente R., Fernández-Gutiérrez B., Jover J.A., et al. Human parvovirus B19, varicella zoster virus, and human herpes virus 6 in temporal artery biopsy specimens of patient with giant cell arteritis: analysis with quantitative real time polymerase chain reaction. Ann Rheum Dis. 2005 May;64(5):780–782.
4. Elling P., Olsson A.T., Elling H. Synchronous variations of the incidence of temporal arteritis and polymyalgia rheumatica in different regions of Denmark; associations with epidemics of Mycoplasma pneumoniae infection. J. Reumatol. 1996;23(1):112–119.
5. Haugeberg G., Bie R., Nordbø S.A. Temporal arteritis associated with Chlamydia pneumoniae DNA detected in an artery specimen. J Rheumatol. 2001:28(7):1738–1739.
6. Gilden D., Nagel M.A. Varicella zoster virus and giant cell arteritis. Curr Opin Infect Dis. 2016;29(3):275–279. DOI: 10.1097/QCO.0000000000000258
7. Frohman L., Wong A.B., Matheos K., Leon-Alvarado L.G., Danesh-Meyer H.V. New developments in giant cell arteritis. Surv Ophthalmol. 2016;61(4):400–421. DOI: 10.1016/j.survophthal.2016.01.001
8. Bhatt A.S., Manzo V.E., Pedamallu C.S., et al. In search of candidate pathogen for giant cell arteritis: sequencing — based characterization of the giant cell arteritis microbiome. Arthritis Rheumatol. 2014;66(7):1939–1944. DOI: 10.1002/art.38631
9. Hayreh S.S., Zimmerman B. Management of giant cell arteritis. Our 27 — year clinical study: new light on old controversies. Ophthalmologica. 2003;217(4):239–259.
10. Weyand C.M., Goronzy J.J. Giant — cell arteritis and polymyalgia rheumatica. N Engl J Med. 2014 Oct 23;371(17):1653. DOI: 10.1056/NEJMc1409206
11. Gonzalez-Gay M.A., Blanco R., Rodriguez-Valverde V., et al. Permanent visual loss and cerebrovascular accidents in giant cell arteritis: predictors and response to treatment. Arthr Rheum. 1998;41(8):1497–1504.
12. Hayreh S.S., Podhajsky P.A., Zimmerman B. Occult giant cell arteritis: ocular manifestation. Am J Ophthalmol. 1998;125(4):521–526.
13. Muratore F., Pipitone N., Salvarani C. Standard and biological treatment in large vessel vasculitis: guidelines and current approaches. Expert Rev Clin Immunol. 2017 Apr;13(4):345–360. DOI: 10.1080/1744666X.2017.1285699
14. González-Gay M.A., García-Porrua C., Llorca J., Gonzalez-Louzano C., Rodriguez-Ledo P. Biopsy-negative giant cell arteritis: clinical spectrum and predictive factors for positive temporal artery biopsy. Semin Arthritis Rheum 2001;30(4):249–256.
15. Breuer G.S., Nesher R., Nesher G. Negative temporal artery biopsies: eventual diagnoses and features of patients with biopsy-negative giant cell arteritis compared to patients without arteritis. Clin Exp Rheumatol. 2008;26(6):1103–1106.
16. Breuer G.S., Nesher R., Nesher G. Effect of biopsy length on the rate of positive temporal artery biopsies. Clin Exp Rheumatol. 2009;27(1 Suppl. 52):S10–S13.
Review
For citations:
Chernukha V.A., Atarschikov D.S., Khamnagdaeva N.V., Pozharov I.V. Giant Cell Arteritis in Ophthalmology Practice: a Case Report. Ophthalmology in Russia. 2019;16(1):109-114. (In Russ.) https://doi.org/10.18008/1816-5095-2019-1-109-114
Views:
2064
Email this article 