gms | German Medical Science

History: A 48 year old female patient N. with no significant history of disease presented to the Hospital with complaints of mild pain in both eyeballs and tear over-secretion. A diagnosis of episcleritis was made and topical steroids were prescribed that had a temporary positive effect. In one month the patient N. presented again because the intensity of eye pain and lacrimation increased as well as visual impairment appeared. After ophthalmoscopic examination ocular ischemic syndrome was suspected. The patient was admitted for full medical and neurological evaluation.

Cardinal symptom by manifestation of disease: On admission clinical examination of other organs and systems revealed low-grade fever (37,7 ̊C), increased arterial blood pressure up to 170/90 mm Hg without difference on both arms, claudication and chilling of hands and feet, intermittent arthralgia (mainly of large and medium joints). Neurological assessment showed no organic disorders or focal neurological deficits.

Diagnostics: Common blood count showed increased erythrocyte sedimentation rate (ESR) up to 45 mm/h. To exclude possible chronic infection or malignancy, tests for viral hepatitis B, C, HIV, Lues, liver function tests, abdominal ultrasound, transthoracic echocardiography and ultrasonography of the mammary glands, gastroscopy, chest X-ray, head MRI were performed and were negative. To exclude systemic disorders tests for ANA, ANCA, C-reactive protein, rheumatoid factor were done however were negative as well. For differential diagnosis computed tomography-angiography of head, neck and thorax with intravenous iodine enhancement was performed: thickening of the walls of ascending aorta and aortic arch, brachiocephalic trunk, right and left common and internal carotid arteries up to 1.5-2.6 mm with narrowing of the lumen was revealed. The diagnosis of TA was made.

Therapy: The treatment using Methylprednisolone (MP) 32?mg/day was initiated together with symptomatic therapy (antihypertensive drugs, antiplatelet agents, anticoagulants).

Further course: The dose of MP was gradually tapered in one month after the symptoms regression.

Disclosures: All authors have nothing to declare.