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Answer 1
  1. Administer IV methylprednisolone 1000 mg. The patient has active signs of giant cell arteritis (GCA), such as fever, weight loss, jaw claudication, and an elevated ESR. The most concerning sign is the visual change. This is a true emergency, as blindness can occur in 1 or both eyes if not treated promptly. Initiating IV methylprednisolone 1000 mg for 3 days and then switching to oral prednisone is the most appropriate treatment to possibly prevent loss of vision.1 This patient’s normal HbA1c level suggests that his diabetes is under control and that the visual changes are not due to diabetes. Waiting for repeat blood cultures as well as starting antibiotics in a patient with negative blood cultures is not indicated. Measuring hydrostatic pressure within the eye with tonometry is important; however, the results would not explain the patient’s painless visual disturbances.

    1. Klein RG, Hunder GC, Stanson AW, Shep SG. Large artery involvement in giant cell (temporal) arteritis. Ann Intern Med 1975;83:806-12.

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