Discussions By Condition: Medical Errors

Temporal Arteritis - A MISSED DIAGNOSIS

Posted In: Medical Errors 1 Replies
  • Posted By: Mrs L. Mamakou
  • November 25, 2006
  • 04:37 PM

November 2006. A MISSED DIAGNOSIS: Report written by Peter Wood, GP Devon, regarding my father's recent illness.

A previously extremely fit 80 year old man presented recently to me with 2 day history of an occipital headache. General examination was unremarkable and as it was possible that the pain was possibly abating a policy of watchful waiting was adopted. The pain did not settle and we met again 2 days later when the pain appeared to be more localised to the face and was worse with movement. Of note was that the patient’s wife drove him to the appointment because of diplopia. Blood tests were arranged and amoxicillin commenced for a presumptive diagnosis of sinusitis. The bloods revealed a raised CRP, and ESR, a nuetrophilia and mildly deranged LFTs. Over the next 3 days the patient was in contact with 3 other doctors initially for advice re fever and later continued pain: during this time the antibiotics were changed to erythromycin which appeared to produce considerable improvement. On review following these 3 days the pain appeared to be lessening but given the abnormal bloods I visited the following day when his general condition seemed even better.

Unfortunately as the antibiotics stopped, his pain increased again and he developed difficulty chewing, another doctor visited him and recommenced the erythromycin and arranged for further bloods.

I visited the following day: he had now lost vision in his right eye and his ESR was still raised – he was admitted with a diagnosis of Temporal Arteritis and commenced on high dose steroids. The visual acuity in his eye is now light perception only.

I present this case as an illustration of the difficulties I had in making this diagnosis and the catastrophic effects of missing it. There were clues: the odd presentation of an infrequent attender with a headache, the diplopia and the raised ESR even in the presence of other abnormalities and later the jaw claudication. Temporal Arteritis affects up to 50 per 100,000 people over 50: the history is not always classical and the apparent initial improvement serves to demonstrate this.

Odd headache; older patient; think Temporal Arteritis.

My family have Dr Wood’s permission to put this report on the internet in accordance with my father’s hopes that the condition might become better understood and more quickly recognised. What this report does not touch on is the terrible suffering that my father went through during the 3 weeks before a correct diagnosis was made. He hopes that by letting his story be told that others might be luckier and not have to suffer in the same way. Losing the sight in his right eye has been a devastating experience but he knows well that it could be much worse for a younger person whose career might be destroyed and family life severely affected.

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  • This almost exact same thing happened to my cousin's wife. She began getting a horrible headache and went to the doctor. She must have also had an ear ache because he dxed ear infection but did put her on steroids and sent her home. She still had the headache but must have also begun to have a jaw ache because yet another doctor told her she could have TMJ. One doctor told her he had no idea. And apparently she saw at least two more before the day she was driving home from having a hair permanent and began seeing double. At that point her husband (my cousin) took her to her opthalmologist, who at that point immediately suspected temporal arteritis -maybe 2 weeks after she first began having headaches. He ran the tests, which came back indicative of the imflammation, wanted to do the biopsy, which was scheduled for about a week later, and put her on a high dose of steroids to try to reduce the inflammation. By the time she was going for her biopsy her vision in one eye, per the test he ran before, was only shadows/light. By the time she went back for her results even that was gone. Then by the time she went back for a follow-up the same thing had happened to her other eye. She's maybe in her 70s and had been fairly active, except for the last couple of years. She's trying to continue to be as independent as possible but is still in the early throes of coming to terms with what's happened. Her daughter is quite upset at all these doctors missing and not even sending her to her eye doctor, who found it, but of course she didn't go to him until she began having vision problems. Who would have?
    Anonymous 42789 Replies
    • February 6, 2011
    • 02:52 AM
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