A Giant (Cell) Mistake - Abstract

71-year-old, left-handed woman, who was referred with ptosis, loss of vision in the right eye and headache. In July 2015 she presented to ER with severe right temporal headache and watery right eye. Her exam and head CT was normal. Her ESR/CRP were elevated. She was allegedly diagnosed with GCA and was started on 50mg prednisone/day that improved her headache. Temporal artery biopsy came back inconclusive. Her headache returned and she noticed some blurred vision in the right eye the prednisone dose was reduced to 40mg/day. She was told to increase the prednisone to 50mg/day. Despite being on high dose oral Prednisone, she continued to lose vision in her right eye and her headache worsened. She presented to ER again in early September and had normal head CT, EKG and elevated ESR again. She was told to continue Prednisone (50mg/day) and was referred to neuro-ophthalmology clinic. At her presentation to neuro-ophthalmology clinic, she complained of loss of vision in the right eye, headache and burning sensation and numbness over the right frontotemporal area. She also reported progressive horizontal and binocular double vision since August 2015 that resolved after she lost vision in the right eye. The medical history was significant for breast cancer (1990s) On exam VA: CF (2-feet) OD, 20/20 OS, Color vision (Ishihara): 0/8 plates OD, 8/8 OS, Pupils were equal in size, and RAPD OD. The external examination of the eyes and orbits was normal OU. The lids showed almost complete ptosis OD. The examination of extra-ocular motility revealed a large angle XT/RHT with significant limitation movement in all directions OD. Automated VF showed diffuse visual field loss OD and was normal OS. Dilated stereoscopic funduscopy revealed pale fundus OD and normal fundus OS.VBfungalinfection