title: Giant cell arteritis with normal erythrocyte sedimentation rate: a management dilemma.
abstract: Two patients with cranial arteritis and normal erythrocyte sedimentation rates of 13 mm/hr. and 26 mm/hr. are presented. One patient became totally blind awaiting temporal artery biopsy. The other patient was a challenge in titrating increased steroid dose with cardiovascular complications against decreased steroid dose with worsening of visual and neurologic problems. Available tests may be negative in active disease. The clinical picture is paramount in decision making, and a high index of suspicion is mandatory. Since a delay of twenty-four hours may be critical, steroids usually should be started as soon as an erythrocyte sedimentation rate has been drawn, without waiting for a biopsy. Once steroid therapy has been started, temporal artery biopsy should be performed conveniently soon, regardless of the erythrocyte sedimentation rate.
mesh_terms: D000368:Aged; D001706:Biopsy; D001766:Blindness / Q000150:complications*; D001799:Blood Sedimentation; D004172:Diplopia / Q000150:complications; D005260:Female; D013700:Giant Cell Arteritis / Q000097:blood* / Q000473:pathology / Q000628:therapy; D006801:Humans; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014792:Visual Acuity
chemical_list: D013256:Steroids