Giant Cell Arteritis Case with Low Inflammatory Markers: A Case Report

CASE REPORT
Abdulrahman Ali M Khormi

 
For citation: Khormi AAM. Giant Cell Arteritis Case with Low Inflammatory Markers: A Case Report. International Journal of Biomedicine. 2026;16(2):266-269. doi:10.21103/Article16(2)_CR1
 
Originally published June 5, 2026

Abstract: 

Giant cell arteritis (GCA), or temporal arteritis, is a common disease of senior age. GCA requires an early diagnosis to avoid serious disability and morbidity in the elderly population. Laboratory findings include elevated ESR and C-reactive protein. However, ESR may be normal in some biopsy-proven cases of GCA. Herein, we report the case of a 57-year-old woman with diabetes mellitus and hypertension who presented with a two-month history of progressive, painless visual loss in the right eye, associated with headache, shoulder girdle pain, and mild morning stiffness. Ophthalmologic evaluation raised concern for arteritic anterior ischemic optic neuropathy (AAION). Despite strong clinical suspicion, laboratory investigations revealed normal ESR and CRP levels prior to glucocorticoid exposure. Temporal artery ultrasound demonstrated subtle wall thickening with a perivascular halo sign involving the right temporal artery, consistent with temporal arteritis. The patient declined a temporal artery biopsy. Empirical high-dose oral glucocorticoid therapy was initiated due to the imminent risk of permanent visual loss, resulting in significant clinical improvement of vision. Given concerns regarding long-term steroid toxicity, particularly poor glycemic control, steroid-sparing therapy with tocilizumab was considered.
This case highlights that GCA may present with normal inflammatory markers and emphasizes the importance of maintaining a high index of clinical suspicion. Normal ESR and CRP values should not delay treatment in patients with compatible clinical and imaging findings, as prompt intervention is critical to prevent irreversible complications.

Keywords: 
giant cell arteritis • temporal arteritis • inflammatory markers • diagnosis • vasculitis
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Received February 7, 2026.
Accepted March 9, 2026.
© 2026 The Author(s). International Journal of Biomedicine is published by IMRDC.
This is an open access article under the CC BY-NC-ND 4.0 license.