A 72-year-old woman comes to the office due to frequent headaches, fatigue, and recent weight loss. Her shoulder muscles feel stiff in the morning. A tender cord is palpated in the right temporal area. The erythrocyte sedimentation rate is 85 mm/hr. Which of the following is the most likely complication of this patient's condition?

Question

A 72-year-old woman comes to the office due to frequent headaches, fatigue, and recent weight loss.  Her shoulder muscles feel stiff in the morning.  A tender cord is palpated in the right temporal area.  The erythrocyte sedimentation rate is 85 mm/hr.  Which of the following is the most likely complication of this patient's condition?

Quizplus · Accepted Answer

The patient has typical features of giant cell arteritis (GCA), also known as temporal arteritis. Manifestations include headache, jaw claudication, muscle fatigue, weight loss, and visual disturbance. On examination, patients have scalp tenderness and a decreased pulse over the temporal artery, which may have a cord-like feel. Many patients with GCA have associated polymyalgia rheumatica, with morning stiffness affecting the shoulders and hips. The erythrocyte sedimentation rate is generally markedly elevated (eg, >50 mm/hr). A feared complication of GCA is permanent vision loss, which can develop in up to 20% of patients and is often sudden, painless, and irreversible. It is often due to anterior ischemic optic neuropathy from the arteritis. Another recognized complication, which has also been noted in 10%-20% of patients, is aortic aneurysm due to large-vessel involvement. Patients with aortic aneurysm are typically followed with serial imaging studies. (Choice A) Chronic lymphocytic leukemia is the most common form of leukemia in older individuals. The presentation is very insidious. Although the exact etiology is unclear, certain chromosomal abnormalities can predispose individuals to this condition. (Choice B) The most common cause of hypothyroidism is chronic lymphocytic thyroiditis (Hashimoto disease). Radiation to the thyroid region predisposes to the development of hypothyroidism. (Choice D) Ulcerative colitis is an inflammatory bowel disease involving the large intestine. It is more common among Ashkenazi Jews, and those with a positive family history. (Choice E) Important causes of membranous glomerulonephritis include hepatitis B and C, syphilis, gold, penicillamine, systemic lupus erythematosus, and rheumatoid arthritis. Many patients have no predisposing factors. Educational objective: Aortic aneurysms can occur in patients with giant cell (temporal) arteritis due to the involvement of the branches of the aorta.

A 72-Year-Old Woman Comes to the Office Due to Frequent