Ivan Ho Shon

INTRODUCTION Giant cell arteritis (GCA) is a chronic medium to large-vessel (LV) vasculitis that commonly presents with ischemic cranial symptoms at onset and structural aortic disease many years after diagnosis. It is well recognized that the disease remains subclinically active in a significant proportion of patients, but the prevalence, vascular distribution, and clinical implications are not well understood.

The patient, a 56-year-old man, was admitted with four weeks of bilateral ankle pain and swelling, lower limb dysesthesia, fatigue, night sweats, fevers, and 10 kg of subacute weight loss. On examination, there was bilateral ankle synovitis and a distal sensory peripheral neuropathy. History included asthma and eosinophilic chronic rhinosinusitis with polypectomy. Nerve conduction studies confirmed sensory neuropathy, and computed tomography (CT) chest demonstrated scattered pulmonary infiltrates.

The patient, a 66-year-old woman, presented to the emergency department with severe occipital and temporal headache, shoulder and neck pain with restricted range of movement, and nonspecific binocular vision disturbance. Initial investigations revealed an elevated C-reactive protein level of 52 mg/L (reference <3 mg/L) and an erythrocyte sedimentation rate of 20 mm/hr (reference range 0–20 mm/hr).