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A healthy 65-year-old womanpresented with 2 days of sustained throbbing, bilateral temporal headache and bilateral blurred vision. Laboratory results are shown in theTable. Given her erythrocyte sedimentation rate (ESR) of 110 mm/h and symptoms concerning for giant cell arteritis (GCA), a temporal artery biopsy was obtained. Results showed a normal caliber lumen without infiltrating inflammatory cells.

Answer D. Serum protein electrophoresis (SPEP) While the patient had a nearly 50% pretest probability of GCA, 1 the negative predictive value of temporal artery biopsy is approximately 83%. 2, 3 The negative biopsy results required consideration of an alternative diagnosis, such as brain abscess, cerebral venous sinus thrombosis, or hypergam-