Case Presentation: A 55 years old females with history of 5-6 months of chronic Right sided Pain and tenderness when shampooing or combing her hair. The pain started as intermittent, but has become constant, associated with Jaw Claudication. She mentioned the pain radiates to her neck and back and reported having episodes of blurry vision in the right side that has worsened in the week prior to her visit. On Exam, The patient had classic findings of prominent, indurated Right temporal artery with significant tenderness on Palpation. Stat Labs showed normal ESR= 2 and CRP= 1.5. Due to high Clinical suspicion the patient was sent to ED for IV Steroids and Temporal Artery Biopsy (which came back negative). She was discharged on high dose Prednisone and on Follow up appointment she reported significant improvement in her symptoms.
Discussion: Temporal arteritis is an inflammation of the temporal artery or any of the cranial arteritis. It carries important clinical value due to significant morbidities associated with it. One of the most Known complications is ophthalmic artery involvement that can cause permanent vision loss. Due to that, early diagnosis and treatment is a key step in improvement of outcomes. American College of Rheumatology established a criteria for TA diagnosis with three out of the following five: Age of 50 years or above, New onset Headache, Temporal Artery tenderness, ESR > 50 or positive Temporal artery biopsy. Our Patient here – Retrospectively- met 3 out of 5. As we can notice here none of the criteria’s is mandatory for diagnosis including the presence of inflammatory markers. Treatment with high steroids resulted in significant clinical improvement in symptoms.
Conclusions: Temporal arteritis (TA) is the most common of all vasculitis. It usually presents sub acutely and can be easily confused with other types of Headaches. One of the most commonly used markers for diagnosis are the inflammatory markers CRP/ESR which are highly sensitive, but still can be negative in around 5% of TA cases as presented in this case. One of the main goals of this case is to educate clinicians that negative ESR/CRP does not necessarily rule out TA, especially with high clinical suspicion.