A 65-year-old woman develops jaw claudication, temporal headache, and sudden vision loss in the right eye. ESR is 120 mm/hr. Temporal artery biopsy shows granulomatous inflammation with giant cells at the media-intima junction, fragmentation of internal elastic lamina, and luminal narrowing. What is the MOST feared complication if untreated?
- A Permanent visual loss from ischemic optic neuropathy due to involvement of posterior ciliary arteries ✓
- B Aortic dissection from ascending aortic involvement
- C Stroke from internal carotid artery granulomatous involvement
- D Myocardial infarction from coronary artery granulomatous arteritis
Explanation
Giant cell (temporal) arteritis most feared complication is irreversible blindness from ischemic optic neuropathy, caused by granulomatous inflammation and thrombotic occlusion of the posterior ciliary arteries supplying the optic nerve head. Once vision loss occurs it is typically permanent. High-dose corticosteroids must be started immediately (even before biopsy confirmation) to prevent visual loss in the other eye. The classic symptom triad of temporal headache, jaw claudication (facial/masseteric artery involvement), and visual symptoms should prompt urgent treatment.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.