BACKGROUND: Giant cell arteritis is an inflammatory disorder of the medium- and 
large-size arteries. Permanent visual loss related to arteritic anterior 
ischemic optic neuropathy is among the most serious complications of this 
disease and initial treatment usually consists of high dose corticosteroids. 
There is no consensus in the literature concerning the optimal therapeutic 
approach in giant cell arteritis patients with corticosteroid-resistant 
arteritic anterior ischemic optic neuropathy.
CASE REPORT: A 73-year-old Caucasian female with biopsy-proven giant cell 
arteritis developed an acute visual loss of the right eye due to arteritic 
anterior ischemic optic neuropathy. Despite 5 daily methylprednisolone pulses, 
systemic symptoms persisted and rapid involvement of the controlateral eye was 
documented. Therefore, tocilizumab (humanised monoclonal antibody binding the 
human interleukin-6 receptor) was introduced as a potential salvage therapy with 
a swift consecutive resolution of the systemic symptoms and stabilization of the 
ophthalmic lesions.
CONCLUSIONS: Although a late effect of steroids pulses cannot be formally ruled 
out in this dramatic situation, tocilizumab likely offered a decisive effect in 
preventing bilateral blindness and may have contributed to steroid tapering. 
Tocilizumab may represent a new early effective second-line treatment option in 
corticosteroid-resistant anterior ischemic optic neuropathy. More data are 
needed to confirm this observation and to evaluate the safety profile of this 
treatment.