# When the Eyes Deceive: Uncommon Ophthalmic Presentation of Giant Cell Arteritis

## TL;DR

A rare case of giant cell arteritis presented with unusual eye symptoms and was managed with steroids.

## Contribution

This case highlights the importance of early steroid treatment and careful tapering in managing GCA.

## Key findings

- A patient with GCA presented with isolated cranial nerve IV palsy and hypertension.
- Steroids resolved symptoms quickly, emphasizing the need for prompt treatment.
- Stopping steroids led to symptom recurrence, underscoring the need for gradual tapering.

## Abstract

Giant cell arteritis (GCA) is a systemic granulomatous large vessel vasculitis that predominantly affects older adults. We present a rare case of a patient in her 60s who presented with hypertension and isolated cranial nerve (CN) IV palsy. Initial imaging and temporal artery biopsy performed were negative. Her symptoms then resurfaced again after her prednisolone was stopped. Re-commencement of steroids led to a quick resolution of her visual symptoms and headaches within a matter of days.

This case highlights the importance of clinical judgement and prompt initiation of steroids without delay. A gradual and prolonged steroid tapering regime is also essential to avoid visual loss, the most feared complication in GCA.