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JAMA Ophthalmology Clinical Challenge
March 18, 2021

Painless Visual Loss in a Septuagenarian

Author Affiliations
  • 1Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
  • 2Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
  • 3Department of Neurology and Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
JAMA Ophthalmol. Published online March 18, 2021. doi:10.1001/jamaophthalmol.2020.4638

A patient in their late 70s with a history of Crohn disease, coronary artery disease, hypercholesterolemia, and transient ischemic attack presented with sudden, painless, left-sided vision loss. They denied headache, scalp tenderness, and jaw claudication. The erythrocyte sedimentation rate (ESR) was 103 mm/h and a magnetic resonance angiographic examination of the brain was negative for mass, infarction, and hemorrhage. Examination results of a right, superficial, temporal artery biopsy specimen showed chronic, nongranulomatous inflammation surrounding adventitial vessels and extensive subintimal fibrosis, without giant cells or segmental loss of the internal elastic lamina, which was interpreted as compatible with temporal arteritis. High-dose corticosteroid therapy was initiated (1 g methylprednisolone intravenously for 3 days followed by 60 mg/d of oral prednisone).

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