Diagnosis of highly occult giant cell arteritis by repeat temporal artery biopsies Some observations

Two patients are presented where clinical judgment appeared to direct the physician to a positive temporal artery biopsy despite a prior negative temporal artery biopsy. In both cases the diagnosis of giant cell arteritis would have been missed with essentially disastrous consequences because the giant cell arteritis was systemically occult, that is, manifesting few other symptoms of the disease. Indurated or tender branches of the superficial temporal arteries should be biopsied preferentially, in our opinion. Biopsy ipsilateral to the involved orbit may also be preferred. Cosmetic consideration should be of only secondary importance.