When the Mimic Coexists with the Mimicked.

Abstract

A 77-year-old male presented with blurred vision in the left eye for the last few weeks. Optic disc on the left was pale and edematous on eye examination. The best uncorrected visual acuity in the right and left eyes was 6/9 and 6/21, respectively. He was reported to have bitemporal headaches as well. Both superficial temporal arteries were hard and nodular with no tenderness on palpation. Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) were 80 mm/h and 45 mg/L, respectively. Complete blood count and serum biochemistry were normal. Although the walls of the superficial temporal arteries were thickened and segmentally stenotic on color Doppler ultrasonography, no characteristic halo sign could be detected. Intravenous pulse methylprednisolone 1 g/day for 3 days followed by 48 mg/day p.o. was initiated after temporal artery biopsy. Visual acuity in the left eye increased gradually to 6/15 and 6/12 at the end of the first and second weeks of corticosteroid therapy, respectively. Erythrocyte sedimentation rate and CRP returned to their normal values as well.