Giant Cell Arteritis Presenting With Isolated Cotton Wool Spots: A Case Report

Background: This case aims to report a patient who presented with reduced vision in her left eye and was diagnosed with giant cell arteritis (GCA) associated with isolated cotton wool spots (CWS).
Brief case description: An 82-year-old woman presented with reduced visual acuity of 20/200 in her left eye for a day.Fundus examination revealed only multiple peripapillary CWS in the left eye.She had an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).A preliminary diagnosis of temporal arteritis, intravenous high-dose steroid therapy was administered for 3 days. Then, the systemic symptoms resolved, and her ESR and CRP dropped.Temporal artery biopsy confirmed the diagnosis of GCA.The next 2 months, in the fundus examination CWS resolved completely.The patient continued using systemic steroids and subcutaneous methotrexate with long-term gradual reduction.
Conclusion: This extreme case should raise awareness for clinicians in the etiological investigation of CWS to identify sight-threatening GCA and promptly initiate appropriate treatment.