Takayasu's Arteritis in a 33-Year-Old Male

Abstract

Takayasu's arteritis (TA), commonly referred to as "pulseless" disease, is a large-vessel inflammatory vasculitis most commonly affecting the aorta and its major branches. Due to its irregular nature, it has the propensity to involve any organ system thus leading to a wide spectrum of clinical features. Most patients affected by TA are females in their second or third decades of lives. Our case is of a 33-year-old male who presented with sudden onset of hypertension for which he was prescribed antihypertensives. Over the next few weeks, he had multiple visits to the emergency department for a variety of different symptoms including fever, myalgias, left arm numbness, and persistence of hypertension. His CT aortogram showed multi-vessel narrowing including that of the celiac axis, superior mesenteric, renal, and internal iliac arteries with right atrophic kidney. At this time, a diagnosis of TA was made and he was started on oral corticosteroid and immunosuppressant therapy and continued to be treated as an outpatient. Nearly five years after his initial symptoms, he presented to the Emergency for acute abdomen, severe vomiting, and constipation, at which time an emergency laparotomy was done and peritonitis was found. A CT angiogram of the abdomen done after this procedure showed tight stenosis of the inferior mesenteric artery (IMA) and proximal stenosis of the left renal artery. He is currently planned for left renal artery and IMA stenting. Our case highlights the important characteristics of TA in male patients and how they differ from females. It also focuses on the importance of early initial workup and diagnosis and the need for a multi-disciplinary team when handling any patient with TA.

Keywords: large vessel vasculitis; takayasu disease; takayasu's arteritis; vasculitis.

Figure 1. CT angiogram abdomen (axial view). Blue arrow indicates atrophic right kidney. Red arrows indicates bilateral renal artery stenosis. Yellow arrow indicates stenosis of inferior mesenteric artery origin.

Figure 2. CT angiogram (sagittal view). Red arrow indicates narrowing at the origin of the common iliac artery.