Which large-vessel vasculitis presents with temporal artery inflammation, jaw claudication, and amaurosis fugax?

• A. Giant cell arteritis
• B. Takayasu arteritis
• C. Polyarteritis nodosa
• D. Kawasaki disease

Answer: (A)

This presentation is classic for giant cell arteritis, a large-vessel vasculitis that typically affects adults over 50. The combination of temporal artery inflammation, jaw claudication, and amaurosis fugax points to ischemia of arteries supplying the head: inflammation of the temporal artery causes tenderness, jaw claudication arises from reduced blood flow to the masticatory muscles, and transient vision loss (amaurosis fugax) reflects compromised flow in the ophthalmic arteries. Prompt treatment is crucial to prevent permanent vision loss, so high-dose glucocorticoids are started even before biopsy results. Diagnostic clues include an elevated inflammatory marker (ESR/CRP) and, on temporal artery biopsy, granulomatous inflammation with multinucleated giant cells and intimal thickening, though treatment should not wait for biopsy. This condition is distinguished from other vasculitides by age and vessel involvement: Takayasu arteritis tends to affect younger patients and large vessels like the aorta, polyarteritis nodosa involves medium-sized arteries with different organ involvement, and Kawasaki disease occurs in children with mucocutaneous findings and coronary artery involvement.