title: Unmasking the elusive giant: an unusual case presenting as third nerve palsy in a patient with scleroderma.
abstract: We report a case of an 80-year-old woman being treated with rituximab and maintenance corticosteroids for long-standing scleroderma who presented with right-sided third nerve palsy. Radiological investigations including CT, MRI and MR angiography of the brain were unremarkable. The patient was discharged with a diagnosis of probable microvascular third nerve palsy but was readmitted 1 week later with total visual loss in her left eye. Despite the absence of diagnostic clinical signs, giant cell arteritis (GCA) was suspected, and she was started on intravenous corticosteroids. Left temporal artery biopsy subsequently confirmed histological findings diagnostic of GCA. Unfortunately, she remained blind in the left eye.
authors.affiliation: Department of Rheumatology, University Hospital Limerick, Dooradoyle, Ireland.
authors.forename: Wan Lin
authors.initials: WL
authors.lastname: Ng
authors.affiliation: Acute Medical Assessment Unit, University Hospital Limerick, Dooradoyle, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: McManus
authors.affiliation: Department of Rheumatology, University Hospital Limerick, Dooradoyle, Ireland.
authors.forename: James Anthony Joseph
authors.initials: JA
authors.lastname: Devlin
authors.affiliation: Department of Rheumatology, University Hospital Limerick, Dooradoyle, Ireland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fraser
mesh_terms: D000369:Aged, 80 and over; D001766:Blindness / Q000209:etiology; D005260:Female; D013700:Giant Cell Arteritis / Q000209:etiology*; D006801:Humans; D015840:Oculomotor Nerve Diseases / Q000209:etiology*; D012595:Scleroderma, Systemic / Q000150:complications*