A 77-yo man had painful necrotic scalp lesions x 9 weeks, lethargy and pain while chewing x 2 weeks, and deteriorating left vision x 3 days. What is the diagnosis?
Lyme disease
Onchocerciasis (river blindness)
Herpes zoster ophthalmicus
Giant cell arteritis
Herpetic keratoconjunctivitis
You are correct. GCA presentations include headache, jaw claudication, scalp tenderness, and polymyalgia rheumatica. Scalp necrosis is rare; it is associated with higher incidence of vision loss. Despite bilaterality of scalp lesions, this patient was initially diagnosed with zoster.