A 70-year-old female presents with severe pain and throbbing in her right temple, scalp tenderness when brushing her hair, jaw claudication while chewing, and transient blurring of vision in her right eye. Erythrocyte sedimentation rate (ESR) is 105 mm/hr. What is the immediate management to prevent irreversible bilateral blindness?

Answer and explanation

Correct answer: C. Initiate immediate high-dose systemic corticosteroids

  1. Step 1: The clinical presentation is classic for Giant Cell (Temporal) Arteritis, a systemic vasculitis of medium and large vessels that predilects older adults.
  2. Step 2: The most feared complication is permanent ischemic optic neuropathy (blindness) due to ophthalmic artery occlusion.
  3. Step 3: Prompt administration of high-dose corticosteroids (e.g., prednisone 40-60 mg daily or IV methylprednisolone if visual symptoms exist) must NEVER be delayed while waiting for a temporal artery biopsy; histology remains positive for up to 2-4 weeks after initiating steroids.
Answer
Initiate immediate high-dose systemic corticosteroids.
Why not the others: 'Withholding steroids until biopsy confirmation' risks catastrophic irreversible bilateral blindness; 'Oral sumatriptan' is contraindicated in vascular ischemic headache; 'Broad-spectrum antibiotics' is useless for non-infectious autoimmune arteritis.

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