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Histologic evidence of giant cell arteritis (GCA) may rarely persist despite long-term treatment with doses of corticosteroids adequate to improve symptoms and normalize the erythrocyte sedimentation rate (ESR).1-3 We describe a patient who had positive findings for GCA on temporal artery biopsy after treatment with prednisone at doses of 30 to 60 mg daily for 6 months. A late biopsy for GCA may be informative, even in the patient treated for months with corticosteroids.
A 71-year-old-woman experienced severe headaches, joint pain, and tenderness of her temporal areas. She had sudden loss of vision in both eyes that was followed by gradual improvement over a few days. The ESR was elevated at 87 mm/h; a presumptive diagnosis of GCA was made, and she was begun on a regimen of prednisone, 60 mg/d, with dramatic improvement in her symptoms. The ESR was 8 and 4 mm/h 1 and 2 months later, respectively, and the prednisone dosage was tapered to 30 mg/d. Approximately 4 months after the onset of symptoms, while on a regimen of 30 mg/d of prednisone and having an ESR of 2 mm/h, she had an uneventful cataract extraction with placement of an intraocular lens implant in the left eye. Her preoperative visual acuities were 20/70 OD and 20/60 OS. Postoperatively, her visual acuity was 20/50 OU. One week after surgery she complained of scalp and temporal area tenderness. Although the ESR was only 5 mm/h, the prednisone dosage was increased to 40 mg/d. Her symptoms abated and the prednisone dosage was tapered to 35 then 30 mg/d over 2-week intervals.
Guevara RA, Newman NJ, Grossniklaus HE. Positive Temporal Artery Biopsy 6 Months After Prednisone Treatment. Arch Ophthalmol. 1998;116(9):1252–1253. doi:https://doi.org/
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