A unique presentation of Takayasu's arteritis in a 39-year-old male with chest pain, vertigo, and blindness

Abstract

Takayasu's arteritis is a rare form of aortic vasculitis, typically described in young Asian females. In this article, we report a unique presentation of type V Takayasu's arteritis in a Hispanic male. To the best of our knowledge, this is the first case of Takayasu's arteritis presenting with the triad of angina, amaurosis fugax, and subclavian steal syndrome. On diagnostic imaging, he was found to have left subclavian and axillary artery stenosis requiring balloon angioplasty. The patient responded to the combination of medical and surgical treatment with full recovery.

Case Report: Takayasu arteritis in a male patient

“…A diagnosis of TA is primarily based on clinical and radiological findings, as the results of biopsy are nonspecific as the histopathology may imitate other types of vasculitis 6 . Suspected TA always warrants prompt vascular imaging, enabling earlier diagnosis and further decreasing the risk to the patient.…”

“…Although angiography was considered to be the standard method for diagnosis of TA, it has been replaced by computed tomography angiography or angiography or magnetic resonance angiography 2 . Furthermore, literature has shown that ultrasound with color Doppler flow imaging and angiography are highly useful for detecting and determining the severity of the disease (except for right brachiocephalic artery) 2,3,6 . However, in our setting, due to limited resources, we only conducted carotid artery Doppler imaging, and the findings were sufficient to achieve a diagnosis of TA.…”

“…As far as treatment is concerned, immunosuppressants such as prednisone and/or methotrexate can lead to significant improvement 3 . Cyclophosphamide is reserved for treatmentresistant cases; a prior study revealed that steroids and cyclophosphamide are effective in the early acute phase when surgical management is not considered 6 . However, in the presence of symptomatic occlusive lesions (fibrotic phase), procedures such as bypass grafts, patch angioplasty, endarterectomy, percutaneous transluminal angioplasty, or stent placement should be considered 3,6 .…”

“…Cyclophosphamide is reserved for treatmentresistant cases; a prior study revealed that steroids and cyclophosphamide are effective in the early acute phase when surgical management is not considered 6 . However, in the presence of symptomatic occlusive lesions (fibrotic phase), procedures such as bypass grafts, patch angioplasty, endarterectomy, percutaneous transluminal angioplasty, or stent placement should be considered 3,6 . Furthermore, despite the ongoing medical treatment, 50% of patients with TA progress to a stage that requires one or more surgical procedures 6 .…”

“…However, in the presence of symptomatic occlusive lesions (fibrotic phase), procedures such as bypass grafts, patch angioplasty, endarterectomy, percutaneous transluminal angioplasty, or stent placement should be considered 3,6 . Furthermore, despite the ongoing medical treatment, 50% of patients with TA progress to a stage that requires one or more surgical procedures 6 . In our case, we started the patient on 60 mg prednisone orally daily, but due to the stenotic lesions, department of vascular surgery was also consulted for a possible endarterectomy.…”