A 70-year-old woman with jaw claudication, temporal headache, and scalp tenderness presents with sudden painless bilateral sequential visual loss. ESR is 110 mm/hr, CRP is elevated, and temporal artery biopsy shows granulomatous inflammation with giant cells. What is the immediate management?
- A Await biopsy results before initiating treatment to confirm the diagnosis
- B IV methylprednisolone 1 g/day for 3 days followed by oral prednisolone ✓
- C Oral prednisolone 1 mg/kg/day immediately and arrange biopsy within 2 weeks
- D Aspirin and NSAID therapy for pain relief while monitoring ESR
Explanation
Giant cell arteritis (temporal arteritis) with visual involvement (AAION or central retinal artery occlusion) requires immediate IV methylprednisolone 1 g/day for 3 days to halt progression of visual loss in the affected eye and prevent contralateral eye involvement. Oral prednisolone alone is insufficient for established visual involvement; IV pulsed steroids are standard of care in this acute vision-threatening scenario. Delaying treatment to await biopsy is contraindicated — the fellow eye can lose vision within hours to days. Biopsy can be performed up to 2 weeks after steroid initiation without significantly reducing diagnostic yield due to the persistence of histological changes. Aspirin/NSAIDs do not prevent vascular occlusion in GCA.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.