A 71-year-old woman comes to the office with a history of headaches, fatigue, and weight loss for 3 months. The headaches are new for her, and usually not very severe. Her jaw also hurts when she is chewing food. Two days prior, she had briefly lost partial vision in her left eye. There were no other neurologic symptoms at the time. On examination, her neck is supple to flexion, fundi and neurologic examinations are normal. She is started on prednisone 60 mg/day and a biopsy is performed to confirm the diagnosis. Which of the following is the most likely change seen on the biopsy to confirm the diagnosis?
A 71-year-old woman comes to the office with a history of headaches, fatigue, and weight loss for 3 months. The headaches are new for her, and usually not very severe. Her jaw also hurts when she is chewing food. Two days prior, she had briefly lost partial vision in her left eye. There were no other neurologic symptoms at the time. On examination, her neck is supple to flexion, fundi and neurologic examinations are normal. She is started on prednisone 60 mg/day and a biopsy is performed to confirm the diagnosis. Which of the following is the most likely change seen on the biopsy to confirm the diagnosis?
💡 Explanation
**Core Concept**
The patient's symptoms are suggestive of a granulomatous inflammation of the optic nerve and surrounding tissues, which is a hallmark of giant cell arteritis (GCA). GCA is a form of large vessel vasculitis that primarily affects the branches of the external carotid artery, particularly the temporal artery.
**Why the Correct Answer is Right**
The biopsy of the temporal artery will likely show a granulomatous inflammation with the presence of giant cells, which is a characteristic feature of GCA. This inflammation is a result of the activation of the immune system, leading to the deposition of immune complexes and the recruitment of inflammatory cells, including giant cells. The granulomatous inflammation is a response to the damage caused by the immune system to the arterial wall, leading to stenosis and eventual occlusion of the artery.
**Why Each Wrong Option is Incorrect**
**Option A:** A biopsy of the temporal artery in GCA would not typically show amyloid deposits, which are more commonly associated with other conditions such as Alzheimer's disease or amyloidosis.
**Option B:** While the patient's symptoms may suggest an inflammatory process, a biopsy of the temporal artery in GCA would not typically show a lymphocytic infiltrate, which is more commonly associated with conditions such as sarcoidosis or lymphoma.
**Option C:** A biopsy of the temporal artery in GCA would not typically show a thrombus, which is more commonly associated with conditions such as deep vein thrombosis or pulmonary embolism.
**Option D:** A biopsy of the temporal artery in GCA would not typically show atherosclerotic changes, which are more commonly associated with conditions such as atherosclerosis or coronary artery disease.
**Clinical Pearl / High-Yield Fact**
Giant cell arteritis is a medical emergency that requires prompt treatment with corticosteroids to prevent visual loss and other complications. The diagnosis is often made based on a combination of clinical symptoms and biopsy results, and prompt treatment can prevent serious complications.
**Correct Answer:** C. Granulomatous inflammation with giant cells.
✓ Correct Answer: B. arteritis with giant cells
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