What question did this study set out to answer?

To highlight atypical presentations of giant cell arteritis where inflammatory markers remain normal.

July 4, 2026Open Access

Giant Cell Arteritis With Normal Inflammatory Markers and Progressive Visual Disturbance

SLSeetha LakshmiTamil University UHUsman HassanUniversity of Kentucky PHPramodh Hettiarachchi

Key Points

To highlight atypical presentations of giant cell arteritis where inflammatory markers remain normal.
Case report of a 75-year-old male with sequential ocular involvement and normal inflammatory markers.
Imaging included carotid/vertebrobasilar studies and 18F-fluorodeoxyglucose PET.
High-dose corticosteroids initiated based on clinical suspicion and imaging findings.
Patient exhibited visual disturbances despite normal erythrocyte sedimentation rate and C-reactive protein levels.
Imaging revealed atherosclerotic changes without critical stenosis.
Vertebral arterial uptake on PET suggested cranial giant cell arteritis.

Abstract

Giant cell arteritis (GCA) is a large vessel vasculitis classically presenting with headache, jaw claudication, visual disturbance, and raised inflammatory markers. However, atypical presentations occur, and a delay in recognition can lead to irreversible visual loss. We report a 75-year-old male with sequential ocular involvement in whom erythrocyte sedimentation rate and C-reactive protein remained within normal limits. Carotid/vertebrobasilar imaging showed atherosclerotic change without critical stenosis, and 18F-fluorodeoxyglucose PET demonstrated vertebral arterial uptake consistent with cranial GCA. High-dose corticosteroids were commenced with rheumatology input. Normal inflammatory indices do not exclude GCA. Clinicians should maintain a high index of suspicion when visual symptoms evolve and initiate treatment without delay where clinical probability is high.

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