A 44-year-old female presents to the emergency department with a right-sided headache. She states the headache is located on the right temple region, is non-radiating, and does not cause photophobia. She is otherwise healthy and has no reported medical problems and has only taken acetaminophen for the pain, which has provided minimal relief. On physical exam, she is alert, awake, and oriented. Her vitals are T 98.8°F, P 78, R 18, and BP 128/76. Her head is normocephalic and atraumatic, and her pupils are equal and reactive. She has tenderness to the right temporal area of the temporal artery, with no swelling, redness, or abnormalities noted. There is no tenderness to the cervical muscles. She exhibits a non-focal neurological exam. A biopsy of the temporal artery reveals inflammatory cells in the artery wall.

Based on the history and biopsy results, what is the best initial treatment for this patient?

A. Cyclosporine
B. Azathioprine
C. Methotrexate
D. Ibuprofen
E. Prednisone

The best initial treatment for a 44-year-old female with symptoms and a biopsy suggestive of temporal arteritis is E) prednisone, a corticosteroid that reduces inflammation.

Explanation:

A 44-year-old female with a right-sided headache, tenderness to the right temporal area, and a biopsy of the temporal artery revealing inflammatory cells of the artery wall most likely has temporal arteritis, also known as giant cell arteritis.

Based on the history and biopsy results, the best initial treatment for this condition is prednisone, which is a corticosteroid used to reduce inflammation and suppress the immune system's response. The other options listed (cyclosporine, azathioprine, methotrexate, and ibuprofen) are not the first-line treatments for temporal arteritis.