Volume 11,Issue 2
Giant Cell Arteritis Presenting with Unilateral Ptosis in a Patient with Schistosomal Cirrhosis: Diagnostic Value of PET/CT in an Atypical Case
Giant cell arteritis (GCA) is a medical emergency in adults older than 50 years because treatment delay may lead to irreversible visual loss or other ischemic injury. We report a 71-year-old man with schistosomal cirrhosis who presented with fever, persistent headache, scalp tenderness, and subsequent right-sided ptosis. The diagnostic process was difficult because his early manifestations were nonspecific, inflammatory abnormalities could initially be interpreted in the context of chronic liver disease, and temporal artery ultrasound was unrevealing. PET/CT subsequently demonstrated diffuse fluorodeoxyglucose uptake involving the bilateral subclavian, carotid, superficial temporal, and peripheral arteries, supporting a diagnosis of large-vessel GCA. After high-dose methylprednisolone was started, the patient experienced rapid symptomatic relief together with marked improvement in inflammatory markers; methotrexate was later added as a glucocorticoid-sparing agent. Management required additional caution because of cirrhosis, abnormal liver biochemistry, and severe hypertension. This case emphasizes three practical points: unilateral ptosis may be an early neuro-ophthalmic signal of GCA even in the absence of overt visual loss, a negative temporal artery ultrasound does not rule out disease when extracranial involvement predominates, and PET/CT can provide decisive evidence when initial cranial imaging fails to explain a highly suspicious presentation.
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