Horton’s disease in elderly women: still an overlooked diagnosis?

Introduction. Horton’s disease is the most common form of vasculitis that occurs in patients older than 50 years. Due to its unusual clinical manifestation, the disease is often misdiagnosed and managed inappropriately. Early diagnosis and prompt initiation of treatment are essential to reduce the risk of severe neuro-ophthalmic complica- tions. Case presentation. We present the case of a 71-year-old woman, with a family history of autoimmune disease, who complains of bilateral shoulder and pelvic girdle pain, low fever, jaw claudication and amaurosis fugax. After the initial tests that have been made in other departments, the patient has been diagnosed with iron deficiency anaemia and treated with iron tablets. Because of the lack of improvement in the clinical manifestations and unresponsive anaemia to oral iron treatment, the patient was admitted to our rheumatology department 5 months later. The anamnestic, clinical and paraclinical tests results along with the presence of the diagnosis criteria, allowed us to establish the Horton’s disease diagnosis. The patient immediately received corticosteroid therapy having a prompt clinical and paraclinical response. Conclusion. Even if sometimes it can be hard to reach the diagnosis, every effort should be made to achieve it. The treatment should be started as soon as the clinical diagnosis has been made to prevent blindness and other potentially irreversible ischemic complications of Horton’s disease.