Giant Cell Arteritis Presenting with Cotton Wool Spots

Abstract

Introduction: Giant cell arteritis is a granulomatous arteritis that often presents to ophthalmology. Methods: Case report. Results: A 69-year-old female presented with moderate vision loss OD after suffering from severe, generalized head and neck pain over the previous 3 months. Fundus examination revealed multifocal cotton wool patches in the posterior pole surrounding the optic disc. A fluorescein angiogram OD demonstrated a large peripapillary choroidal filling defect. Erythrocyte sedimentation rate was 86 mm/hr and her C-reactive protein was 9.2 mg/dL. She was immediately started on intravenous corticosteroid therapy, and she noted rapid improvement of her symptoms. A temporal artery biopsy was positive for giant cell arteritis. Conclusion: Ophthalmologists should be aware that cotton wool patches may be the presenting sign of giant cell arteritis. Fluorescein angiography may be helpful in these cases to demonstrate concomitant choroidal ischemia.

KEYWORDS:

• giant cell arteritis
• cotton wool patches