A Fatal Triad of Myeloradiculitis, Multifocal Cerebral Infarction, and Central Retinal Artery Occlusion Revealing Occult Giant Cell Arteritis

Giant cell arteritis (GCA) is the most common primary systemic vasculitis in adults over 50 years of age and classically presents with cranial symptoms such as headache, jaw claudication, and scalp tenderness.Spinal cord involvement is exceedingly rare and easily mistaken for degenerative spinal disease, particularly when headache, jaw claudication, and scalp tenderness are absent.We report the case of a 61-year-old woman whose illness evolved over several months, beginning with a lower-limb deficit and sciatica misdiagnosed as a disc herniation and treated surgically without improvement.Only when a contralateral deficit, a sensory level, and sphincter dysfunction emerged was a thoracic myeloradiculitis recognized on MRI.Days before admission, an acute monocular visual loss and a new upper-limb deficit revealed a more extensive process, and biopsy-confirmed GCA with large-vessel involvement and multifocal cerebral lesions was ultimately diagnosed.Despite an initial partial response to high-dose glucocorticoids, the patient died of septic shock before advanced imaging for disease-extent assessment could be performed, owing to local resource constraints.This case illustrates the diagnostic pitfalls of spinal-onset GCA without headache, jaw claudication, or scalp tenderness, and the infectious risk of high-dose glucocorticoid therapy in severe largevessel disease.