Too Young to Undergo Temporal Artery Biopsy? Calciphylaxis-Related Anterior Ischemic Optic Neuropathy

Abstract

A 39-year-old male patient with end-stage renal failure presented with unexplained isolated unilateral anterior ischemic optic neuropathy, high sedimentation rate, and high CRP. Despite the relatively young age of the patient, an ipsilateral temporal artery biopsy was performed, disclosing calciphylaxis, a highly morbid condition associated with end-stage renal failure, which requires urgent, specific management.

Diagnosis and management of giant cell arteritis: Major review

“…The differential diagnosis for GCA include other vasculitis, other causes of amaurosis fugax, other conditions presenting with new onset headache, infections, Ig G4 disease, connective tissue disorders, lymphoproliferative diseases, amyloidosis and calciphylaxis. [160][161][162][163][164][165]…”

Calciphylaxis a Giant Cell Arteritis Mimic: A Case Report and Review of the Literature

“…CPA is a rare but increasingly recognized condition that can mimic GCA. There are 10 other reported cases of acute optic neuropathy due to calciphylaxis (Table 1) (2–10). Common ophthalmic manifestations include acute visual loss, a RAPD, and pallid optic disc edema.…”

“…Common patient characteristics included 7 patients with CKD (2–6,8,10). Of the 3 patients without CKD, 1 was on hemodialysis for uremia and volume overload with laboratory findings of improper phosphorus balance (3), 1 was on chronic steroids for her rheumatoid arthritis (9), and 1 patient's medical history was unknown (7).…”

“…ESR was commonly elevated as was either parathyroid hormone or phosphorus. Eight patients were on a course of steroids (7 on high dose (2,3,5–8)) for presumed GCA but were discontinued when no improvement in vision was seen or when biopsy indicated CPA (10). Sodium thiosulfate was given to 2 patients, as well as our patient, but again, no improvement was observed (9,10).…”

“…Eight patients were on a course of steroids (7 on high dose (2,3,5–8)) for presumed GCA but were discontinued when no improvement in vision was seen or when biopsy indicated CPA (10). Sodium thiosulfate was given to 2 patients, as well as our patient, but again, no improvement was observed (9,10). Three of the 7 patients, whose clinic outcomes are known, died within a year of visual presentation (3,6,8).…”