Delayed recognition of giant cell arteritis presenting as ear pain leading to vision loss: First biopsy-proven case encountered at a tertiary eye center in Oman

Abstract:

A 70-year-old Omani male with a history of poorly controlled diabetes, hypertension, and dyslipidemia presented with a 6-month history of persistent right ear and temporomandibular joint pain, culminating in sudden painless vision loss in the right eye and jaw claudication. Despite multiple prior consultations and misdiagnoses, the diagnosis of giant cell arteritis (GCA) was only made after ophthalmologic assessment revealed arteritic anterior ischemic optic neuropathy. Bilateral temporal artery biopsies confirmed GCA. The patient was managed with intravenous methylprednisolone, oral steroids, methotrexate, and later Tocilizumab. While systemic symptoms improved, vision loss was irreversible. This case underscores the diagnostic challenges of GCA in regions with low prevalence and highlights the importance of early recognition to prevent blindness.