New headaches with normal inflammatory markers: an early atypical presentation of giant cell arteritis

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Colleges, School and Institutes


An 80-year-old man presented repeatedly to his general practitioner with 3 months of unexplained persistent frontal headaches. CT head revealed no diagnosis. His dentist diagnosed his co-existing jaw pain as bruxism. Three months later, the patient happened to attend a routine ophthalmology follow-up appointment. During this routine appointment, features of giant cell arteritis (GCA) including worrying visual complications were first noted. His inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) were not significantly raised-contrary to the norm. A temporal artery ultrasound and biopsy were performed, in light of the history. This confirmed GCA. He was commenced on high-dose oral prednisolone and was managed by ophthalmology and rheumatology. At 4 weeks, symptoms resolved with no permanent visual loss despite a prolonged initial symptomatic period. Multiple symptomatic presentations to different specialties should therefore alert clinicians to a unifying diagnosis, for example, vasculitis. Serious illnesses may present with severe symptoms despite normal screening investigations.


Original languageEnglish
JournalBMJ case reports
Publication statusPublished - 27 Jun 2018


  • Blood Sedimentation, C-Reactive Protein/analysis, Giant Cell Arteritis/complications, Headache/diagnosis, Humans, Incidental Findings, Male, Vision Disorders/diagnosis