An 80 yo M presents to clinic with complaint of muscle pain and weakness in his shoulders.
History & Physical Exam
- He recently noticed pain in his temples (worse on L) and difficulty chewing because his jaw will become tired.
- He had one episode of transient vision loss in his L eye, but this resolved within 2-3 minutes and has not recurred. He has never had these symptoms before.
- He has had some low-grade fevers recently, but thought this was secondary to being around his grandchildren.
- He is also having difficulty lifting his arms above his head when he tries to wash his hair in the shower.
- On PE, he is unable to lift his shoulders above his head without discomfort, and he has tenderness to touch of his L temple. His vision is normal in clinic today.
- His vital signs are within normal limits.
Diagnostic Workup
- ESR and CRP are both elevated.
- CBC and CMP are within normal limits.
Treatment & Management
- Start on high dose steroids (1 mg/kg)
- Schedule temporal artery biopsy within the next 2 weeks
A 75 yo F presents to clinic with complaint of scalp pain when she brushes her hair that started 1 week ago.
She finished treatment for breast cancer about 2 months ago and has been doing well other than recent-onset scalp tenderness.
History & Physical Exam
- One month ago, she went on a trip to the Netherlands to visit her childhood home.
- She denies any jaw claudication, vision loss, or muscle pain/weakness, or temporal artery tenderness.
- Vital signs are within normal limits.
- PE is unremarkable.
Diagnostic Workup
- ESR and CRP are mildly elevated.
- CBC and CMP are unremarkable.
Treatment & Management
- Close follow-up in the clinic to monitor for changes in symptoms.
- She needs to be made aware of signs to look out for, such as jaw claudication, temporal headaches or tenderness, and most importantly, vision changes.
- If she were to experience any changes in vision, steroids would need to be promptly started without waiting for imaging or biopsy.