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Case Report Volume 16 Issue 3
A giant in disguise: giant cell arteritis presenting with optic nerve edema without the usual symptoms – a case report
, Verdana">, ">Emma A Horstkamp, Virginia O Bice, Chad E Gosnell, Len V Koh
Received: October 31, 2026 | Published: November 12, 2026
Citation: Horstkamp EA, Bice VO, Gosnell CE, et al. A giant in disguise: giant cell arteritis presenting with optic nerve edema without the usual symptoms – a case report. Adv Ophthalmol Vis Syst. 2026;16(2):72-75. DOI: 10.15406/aovs.2026.16.00513
Abstract
Background: Giant cell arteritis (GCA) is a medical emergency that most often presents with headaches, jaw claudication, scalp tenderness, and systemic symptoms. Atypical or minimally symptomatic presentations can delay diagnosis and place vision at risk. Prompt recognition, laboratory evaluation, and early systemic corticosteroid therapy are essential to prevent irreversible vision loss.
Case report: A 74-year-old white male presented with one day of a brown hue, light
flashes, eye pain, color vision change, and visual hallucinations in the left eye. He denied
temporal headache and jaw claudication. Visual acuity was 20/20 in both eyes with no
afferent pupillary defect, but the left optic nerve showed chalky, pale edema from 07:00-
13:00 clock hour confirmed by optical coherence tomography. Non-arteritic anterior
ischemic optic neuropathy was the leading differential, but because of the risk of impending
vision loss he was sent for same-day laboratory testing. Erythrocyte sedimentation rate (73,
[ref 0-15mm/hr]) and C-reactive protein (122, [ref <5mg/L]) were markedly elevated. He
was admitted, received three days of intravenous corticosteroids, and a temporal artery
biopsy performed four days after presentation was positive for GCA. He was transitioned
to oral prednisone 60 mg daily. At two-week follow-up, the optic nerve edema had resolved,
inflammatory markers had normalized, visual acuity remained 20/20, and a residual inferior
arcuate defect persisted in the left eye.
Conclusion: GCA can be presented without the classic symptoms. Any edematous optic
nerve in a patient over 50 years of age warrants investigation for GCA, and elevated
inflammatory markers should prompt initiation of intravenous corticosteroids while
awaiting temporal artery biopsy
Keywords: giant cell arteritis, temporal arteritis, optic nerve edema, arteritic anterior ischemic optic neuropathy, erythrocyte sedimentation rate, C-reactive protein, corticosteroids
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