A case of atypical Takayasu arteritis initially presenting with peripheral artery disease

Abstract

A 28-year-old woman developed Raynaud's phenomenon and sudden left visual loss due to hypertensive retinopathy. One and a half years later, she noticed peripheral coldness and numbness of right foot. Enhanced computed tomography showed remarkable stenosis of left radial and bilateral tibial arteries. Initially, the diagnosis of idiopathic peripheral arterial occlusive disease (PAD) was made. PAD gradually progressed despite the medication with antiplatelet drug and vasodilator, and coronary angiography revealed a left coronary artery aneurysm. Then, she developed the same ischemic symptom of right hand and left visual loss caused by papilledema. Although 18 F-fluorodeoxyglucose positron-emission tomography showed no abnormalities, and both HLA-B52 and HLA-B39 were negative, she was diagnosed with atypical Takayasu arteritis (TA) by exclusion of other possible diseases. To the best of our knowledge, this is the first case of TA with coronary aneurysm and PAD. In TA patients, the involvement of medium-sized vascular lesion such as peripheral extremity arteries should be considered.

Nonatherosclerotic Peripheral Artery Disease

“…Many patients initially complain of fever, arthralgias, and malaise. Although the most common symptom of TA is arm claudication, observed in greater than 60% of cases, aortoiliac artery involvement can result in lower limb ischemic symptoms, and even the femoral artery may be involved [26,27].…”