TY - JOUR T1 - New headaches with normal inflammatory markers: an early atypical presentation of giant cell arteritis JF - BMJ Case Reports DO - 10.1136/bcr-2017-223240 VL - 2018 SP - bcr-2017-223240 AU - Ruchir Singh AU - Ilfita Sahbudin AU - Andrew Filer Y1 - 2018/06/27 UR - http://casereports.bmj.com/content/2018/bcr-2017-223240.abstract N2 - An 80-year-old man presented repeatedly to his general practitioner with 3 months of unexplained persistent frontal headaches. CT head revealed no diagnosis. His dentist diagnosed his co-existing jaw pain as bruxism. Three months later, the patient happened to attend a routine ophthalmology follow-up appointment. During this routine appointment, features of giant cell arteritis (GCA) including worrying visual complications were first noted. His inflammatory markers (C-reactive protein and erythrocyte sedimentation rate) were not significantly raised—contrary to the norm. A temporal artery ultrasound and biopsy were performed, in light of the history. This confirmed GCA. He was commenced on high-dose oral prednisolone and was managed by ophthalmology and rheumatology. At 4 weeks, symptoms resolved with no permanent visual loss despite a prolonged initial symptomatic period. Multiple symptomatic presentations to different specialties should therefore alert clinicians to a unifying diagnosis, for example, vasculitis. Serious illnesses may present with severe symptoms despite normal screening investigations. ER -