Giant cell arteritis: a not-so-straightforward diagnosis in routine practice

Abstract

We discuss the case of a 70-year-old female who presented acutely with temporal headache and vision disturbance. She was commenced on high dose glucocorticosteroids and a subsequent temporal artery biopsy revealed granulomatous inflammation affecting all layers of the temporal artery, confirming the suspected diagnosis of giant cell arteritis (GCA). At present, there are four validated histological patterns for the diagnosis of GCA. Nonetheless, the diagnosis of GCA remains challenging in subtle cases which do not show the “classic” histological features. There is currently a lack of agreement among experienced pathologists regarding the diagnostic features and classification of inflammation observed in TAB sections in the diagnosis of GCA. Recent research has attempted to standardize the minimum reporting criteria for the diagnosis of GCA however international controversy remains, justifying further work in this field.