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A 79 year old non-smoking white woman presented with six weeks of progressive malaise and a one week history of difficulty eating because of a swollen, tender tongue. Her left visual acuity had suddenly dropped, which prompted emergency assessment. Examination showed bilateral swollen optic discs and a necrotic tongue lesion. Her erythrocyte sedimentation rate was 98 mm in the first hour. She was urgently treated with pulsed intravenous and oral corticosteroids. Her symptoms improved and the focal lesion resolved within a week. Extracranial features of giant cell arteritis, such as ischaemia of the tongue secondary to involvement of the lingual artery, are uncommon but valuable signs that help diagnosis.diagnosis.