Diagnostic Dilemmas in Giant Cell Arteritis: Overcoming Anchoring Bias

TL;DR

This case report highlights the diagnostic challenges of giant cell arteritis due to nonspecific symptoms and anchoring bias, emphasizing the need for improved awareness and protocols.

Contribution

The paper presents a case where GCA was diagnosed after initial missteps, emphasizing the role of anchoring bias in delayed diagnosis.

Findings

The patient was diagnosed with GCA after elevated ESR and CRP levels and a temporal artery biopsy.

Diagnostic delays occurred due to nonspecific symptoms and anchoring bias.

The case highlights the importance of prompt evaluation and awareness to prevent complications.

Abstract

Giant cell arteritis (GCA), also known as temporal arteritis, is the most common systemic vasculitis in individuals over 50 and presents diagnostic challenges due to its nonspecific symptoms such as fever, headache, and fatigue. This case report describes the details of a male patient in his 70s who presented with recurrent intermittent fevers of unknown origin and was ultimately diagnosed with GCA after an extensive workup. His initial CT scans and lab tests were unremarkable. However, after a rheumatological workup displayed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, along with new symptoms of ataxia and headaches, a temporal artery biopsy (TAB) was performed and confirmed the patient had GCA. This case underscores the difficulty in diagnosing GCA primarily due to physician anchoring bias, particularly when typical symptoms are not present. The case also showcases the need for increased awareness and prompt evaluation of potential GCA symptoms to prevent severe complications. Public education as well as improved hospital protocols can lead to earlier detection and treatment of GCA, reducing the risk of morbidity.

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