Sudden onset vision loss: an atypical presentation of giant cell arteritis and myeloproliferative neoplasm

A 75-year-old man was referred to our centre with a history of sudden onset painless loss of vision in the right eye, on a background of recent jaw claudication and weight loss. The visual loss developed suddenly 5 days before presentation. His medical history included hypertension, hyperlipidaemia, prior ischaemic stroke, and a 40-pack-year smoking history.

Visual acuity was reduced to hand movements in the right eye and 6/7.5 in the left eye. The swinging light test demonstrated a right relative afferent pupillary defect. Fundus examination of the right eye demonstrated a pale swollen disk, retinal oedema and pallor, and a mild “cherry red” spot, suggestive of a central retinal artery occlusion (CRAO). The fundus of the left eye appeared normal...