an 83-year - old woman presented with sudden visual loss that had developed in both eyes ( oculus uterque , ou ) the previous day .
she did not complain of any associated headache , scalp tenderness , jaw claudication or constitutional symptoms such as weight loss , fever , malaise or sweats .
her visual acuities included perception of light in the right eye ( oculus dexter , od ) and perception of hand motion in the left eye ( oculus sinister , os ) .
fundus examination revealed mild retinal arterial narrowing and chalky - white disc swelling ou ( fig .
the results of the hardy - rand - rittler test and ishihara test showed total dyschromatopsia ou .
although electroretinography findings were within normal limits , visual evoked potentials showed delayed p100 latency ou .
brain magnetic resonance imaging scans and angiography results showed diffuse bilateral stenosis of vertebral arteries and external carotid arteries without significant intracranial vessels stenosis .
the crp level , esr and platelet count were elevated and measured to be 5 mg / dl ( upper normal limit , 0.5 mg / dl ) , 55 mm / h ( upper normal limit , 20 mm / h ) , and 510 k/l ( upper normal limit , 400 k/l ) , respectively . following a presumptive diagnosis of silent gca - associated aaion ou , the patient was hospitalized and treated with intravenous 250 mg methylprednisolone every 6 hours for 3 days . biopsy of the left temporal artery was performed , and 3 cm of the temporal artery was acquired .
lymphocytes , epithelioid histiocytes , and multinucleated giant cells had diffusely infiltrated into the entire vessel wall , especially in the arterial wall media ( fig .
after 7 days , the patient 's visual acuity os improved slightly to being able to count fingers .
the crp level and esr decreased to 1.07 mg / dl and 30 mm / h , respectively .
oral prednisolone therapy was slowly tapered down from 60 mg per day , and steroid treatment was maintained with deflazacort 30 mg per day .
however , after 4 months , the patient 's visual acuities deteriorated to no light perception od and light perception os .
gca should be strongly suspected when patients greater than 50 years of age present with headaches .
the incidence of gca in scandivian countries and north america ranges between 6.9 and 32.8 per 100,000 .
however , the occurrence of gca is rare in african americans , hispanics , and asians [ 8 - 10 ] .
there have only been a few reports of gca among asians [ 5,6,11 - 15 ] . in japan
, a nationwide gca survey revealed an extremely low prevalence of 1.47 per 100,000 population , which is approximately 1 / 140 of that reported in the us .
pereira et al .   reported that gca was seen 20 times less frequently in asians than in caucasians .
.   stated that , for over a period of 22 years , only 7 patients were diagnosed with gca by temporal artery biopsy in a tertiary medical center in saudi arabia .
the incidence of gca in asians was far lower than that in caucasians ; however , the incidence is now increasing in the asian population .
after 36 years of no reported cases of gca , in 2010 , aui - aree et al .   reported 4 gca cases in thailand .
cullen et al .   noted that of the 7 biopsy - confirmed gca cases reported over the past 10 years in singapore , 3 were reported in 2009 .
this trend may be associated with an increase in the maximum life span of the asian population
. suspected diagnosis of gca by rheumatologists and ophthalmologists , along with extensive laboratory tests , may be other important factors .
however , a nation - wide epidemiologic study would be needed to clarify the association of life span and gca incidence in asians . in korea ,
only a few biopsy - confirmed gca cases have been reported ; however , there have been no gca - associated aaion cases so far . to our knowledge , this is the first biopsy - confirmed report of gca - associated aaion in korea . our patient was diagnosed with silent gca , and the clinical features overlapped with non - arteritic aion .
when asian patients aged > 50 years present with acute visual loss and disc swelling and no other symptom , non - arteritic aion accounts for more than 90% of these cases . in such circumstances , laboratory parameters , such as esr , crp level and platelet count can serve as indicators in the diagnosis of gca .
reported that the crp level has a sensitivity of 100% for gca , and the combination of crp level and esr has a specificity of 97% . in a large population - based cross - sectional study ,
documented that the odds of a positive biopsy were 1.5 times greater with an esr of 47 to 100 mm / h , 5.3 times greater with a crp of > 2.45 mg / dl , and 4.2 times greater with a platelet count of > 400,000 l .
the above 3 parameters were elevated in our patient ( crp , 5 mg / dl ; esr , 55 mm / h ; and platelet count , 510 k/l ) .
these test results are known to be normal in non - arteritic aion . in conclusion , although this disease is rare in asians , gca - associated aaion should be considered when an elderly patient presents with sudden visual loss and disc edema .
gca should be suspected and laboratory tests should be performed , even in the absence of typical symptoms .
 giant cell arteritis ( gca ) is a rare disease among asians . 
 arteritic anterior ischemic optic neuropathy , which accompanies gca , has not yet been reported in koreans . 
 diagnosis of gca is difficult if typical symptoms other than visual loss are absent . here 
 , we report a case of an 83-year - old korean woman presenting with sudden visual loss in both eyes ( oculus uterque , ou ) . 
 her visual acuities included perception of light in the right eye ( oculus dexter , od ) and perception of hand motion in the left eye ( oculus sinister , os ) . 
 the results of the hardy - rand - rittler test and ishihara test showed total dyschromatopsia ou . 
 the goldmann perimetry test revealed a total field defect od and paracentral island os . 
 fundus examination revealed chalky - white disc swelling ou . 
 other systemic symptoms and signs were unremarkable . 
 the erythrocyte sedimentation rate , c - reactive protein and platelet count were highly elevated . 
 temporal artery biopsy revealed multiple lymphocytes and multinucleated giant cells in the arterial media layer . to our knowledge , this is the first report of gca in a korean that has been confirmed with temporal artery biopsy . in conclusion 
 , silent gca can occur in koreans , and hence , elderly patients presenting with chalky - white disc swelling , and corresponding laboratory findings must be evaluated for gca . 