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Show Importance of Clinical Judgment in the Diagnosis of Temporal (Giant Cell) Arteritis I attended the Walsh session at the 35th Annual NANOS meeting in Lake Tahoe in 2011, where the very inter-esting case report "Occult Temporal Arteritis in a 54-Year- Old Man" by Levin et al (1) was first presented, and I was happy to see it is published. In 2008, at the Annual Meeting of the American Academy of Ophthalmology, we presented our review of 3,001 temporal artery biopsies performed in the Kaiser Foundation Health Plan from 1997 to 2006. We found 17 of 459 positive biopsies in the 50-59 years old range, and of these, only 3 were in men. What is even more remarkable about the patient reported by Levin et al is that his eryth-rocyte sedimentation rate, C-reactive protein, and platelet count were normal. At the 2010 Annual Meeting of the American Academy of Ophthalmology, we reported on the prevalence of positive temporal artery biopsies in the setting of normal laboratory values. Of the 459 patients with pos-itive temporal artery biopsies, 20% had a normal erythro-cyte sedimentation rate, 5% had a normal C-reactive protein, and 55% had normal platelets. We found that only 2 of the 459 patients had all the 3 laboratory values within normal limits (although not all patients had all 3 tests performed). Giant cell arteritis is primarily a disease of elderly white women with abnormal laboratory test results supporting the diagnosis. Levin et al remind us that a high index of suspicion is essential in making the diagnosis of giant cell arteritis. Matthew D. Walvick, DO University of California San Francisco Fresno, California mwalvick@fresno.ucsf.edu The author reports no conflicts of interest. REFERENCE 1. Levin F, Schubert HD, Merriam JC, Blume RS, Odel JG. Occult temporal arteritis in a 54-year-old man. J Neuroophthalmol. 2011;31:153-154. Erratum In the Letter to the Editor (1) titled "Atypical central serous chorioretinopathy with peripapillary subretinal fluid suggesting an optic neuropathy," an author was inadvertently omitted. The second author is Vivek R. Patel, MD, University of Ottawa Eye Institute, Ottawa, Canada. Dr. Patel reports no disclosures. The authors regret the error. REFERENCE 1. Johnson D, Patel VR. Atypical central serous chorioretinopathy with peripapillary subretinal fluid suggesting an optic neuropathy. J Neuroophthalmol. 2009;29:155-156. Letter to the Editor: J Neuro-Ophthalmol 2011; 31: 397 397 Letter to the Editor Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |