Transient cough-induced blindness in temporal arteritis

A 71-year-old previously healthy man, vacationing in Arizona, was admitted for a 1-month history of cough and progressive fatigue limiting his ambulation. With paroxysms of coughing, he described bilateral vision loss for 5 to 10 seconds. His vision grayed and “tunneled down” (i.e., from periphery to center) before blindness. Sometimes, he had transient bilateral blurring with “stars” but no diplopia. He denied presyncope. There was no hemoptysis, dyspnea, or pleurisy. He had no headache, scalp tenderness, jaw claudication, or morning stiffness, but had diffuse bone and muscle pains. He had constitutional symptoms including anorexia, night sweats, and 20-lb weight loss. Other than his Arizona holiday, his infectious contact and medical history was unremarkable. He had low risk of atherosclerosis: he was fit and a nonsmoker, had no family history, and had systolic pressures <135 mm Hg without bruits, low-density lipoprotein–cholesterol of 2.3 mmol/L, hemoglobin A1c of 5.8%, and normal baseline EKG. In hospital he had fevers from 38.7 to 40.4°. There was no lymphadenopathy or temporal artery tenderness. …