Age: 73.0
Sex: F
Vaccine: COVID19-2
Symptoms: Red blood cell sedimentation rate increased, Red blood cell sedimentation rate normal, Swelling face, Swelling of eyelid, Tenderness
Clinical narrative: Sometime in early February 2023, I had an episode in which I had a blurry spot in the vision of my right eye for about 20 minutes. On 2/14/2023, I experienced symptoms that led me to seek medical attention. I had sagging of the right eyelid, swelling and tenderness at the right temple, and slight itching at the right temple. On 2/15/2023 or 2/16/2023, I still had the aforementioned symptoms, plus I also developed stiffness in the neck. Also, the occipital area was sore to the touch. I saw my PCP on 2/16/2023, and he suspected that I could have temporal arteritis, so he withdrew blood to test the erythrocyte sedimentation rate. Sometime between 2/16/2023 and 2/19/2023, I also developed jaw claudication. On 2/20/2023, I got the blood test results back, and it indicated that the erythrocyte sedimentation rate was 40, which indicated possible temporal arteritis. My PCP then recommended a right artery biopsy to confirm diagnosis. He also prescribed 60mg of prednisone, which I was to take daily. That was also the day that I developed swelling in the left temporal area; there was also slight sagging in the left eyelid, but it was less pronounced than the sagging of the right eyelid. On 2/21/2023, I underwent the biopsy. On 2/22/2023, I received the biopsy results, which confirmed a diagnosis of temporal arteritis. On 2/24/2023, I underwent another blood test to have inflammation markers tested; that day, the erythrocyte sedimentation rate was 38, and the C-reactive rate was six. After beginning the prednisone, I began to have improvement in symptoms. The head and neck pain were gone, plus the jaw claudication was reduced. The swelling of the left temporal area was reduced, and the sagging in both eyelids improved a few days after I began the prednisone. On 3/7/2023, I had another episode in which I had a blurry spot in the vision of my right eye. This time, the blurring lasted for about 30 minutes. I went to an ophthalmologist on 3/13/2023 to have my eye pressure checked. The ophthalmologist was unable to explain the episodes with the blurry spots. The pressure of the left eye was 16, and the pressure in the right eye was 13. On 3/29/2023, I began taking weekly injections of 162 mL of ACTEMRA. By this point, most of my symptoms had gone, though I still had some mild jaw claudication. By 4/13/2023, I had gradually reduced the prednisone dosage from 60mg to 30mg a day. On about 4/15/2023, the blurring episodes had become more frequent and longer lasting; they lasted for up to two hours.  On 4/17/2023, I experienced partial blindness in the right eye, which increased over time and persists to this day. I returned to the ophthalmologist on 4/18/2023. I underwent a field vision test and a basic eye exam. They confirmed that there was damage to the right optic nerve. My rheumatologist increased the prednisone dosage back to 60mg daily in order to stop the inflammation and further vision loss. They also had me receive prednisone infusions for three days on 4/20/2023, 4/21/2023, and 4/23/2023. My vision loss continued to increase as I was receiving corticosteroid treatment until it stabilized on 4/26/2023. On 5/2/2023, I underwent a blood test; the erythrocyte sedimentation rate was two, and the C-reactive protein rate was less than one. At the time of this writing, aside from the vision loss, the symptoms have all resolved.