(576) Giant Cell Arteritis Triggered by COVID-19 Infection: A Rare Occurrence

Introduction: Giant Cell Arteritis is a large vessel vasculitis. It is the inflammation of blood vessels with a granulomatous process involving vessels from the aorta to its major branches, leading to presentation variation.

Description: An 81-year-old Hispanic male with a history of hypothyroidism, chronic kidney disease stage 3, and type 2 diabetes mellitus was previously admitted for generalized weakness secondary to untreated COVID-19 infection. He presented with complaints of progressive generalized weakness and vision changes. The vision changes were sudden with the sensation of a curtain coming down over his eyes that progressed from the left to include the right eye now. He noted associated bitemporal headaches since 5 weeks ago and pain in the shoulders and thighs.
He was mildly hypertensive with a low-grade fever of 37.5 C. He had edema and tenderness of the bilateral eyelids with vision loss. His blood work was unremarkable. He was COVID-19 positive. ESR and CRP were 95 and 239, respectively. Bedside ultrasound was concerning for papilledema. Workup with MRI ruled out pseudotumor cerebri and cerebral venous sinus thrombosis. A lumbar puncture was done to rule out meningitis. The results showed no underlying infection or oligoclonal bands. Further workup with ANA, ANCA, rheumatoid factor, dsDNA antibodies, smooth antibody, anti-SSA antibody, anti-SSB antibody, and scl -70 antibody were negative.
Ophthalmology evaluation noted bilateral optic nerve swelling consistent with increased intracranial pressure but the optic nerves were pale; suspicious of a chronic process.
Neurology noted the possibility of giant cell arteritis in the setting of possible polymalgia rheumatica given pain in the shoulders and thighs. A temporal artery biopsy confirmed the diagnosis. He received prednisone and 3 days of IVIG. He was given a single dose of Tocilizumab as well.
The patient showed no improvement in symptoms and was discharged to follow-up outpatient however has not been able to regain vision since discharge.

Discussion: Ocular involvement with GCA has wide variability. Vision loss is a devastating complication that leads patients to become very concerned about methods to improve and possibly cure visual impairment. GCA should be considered in patients with ocular involvement in the post-COVID era.