UNUSUAL PRESENTATION OF A CASE OF TAKAYASU ARTERITIS
AbstractTakayasu arteritis is a rare disease of medium size and large vessels causing granulomatous inflammation of the involved territory. The most usual area involved is the arch of the aorta and its major branches. We came across an atypical presentation of this rare disease in our medicine department at Lahore General Hospital. A 52-year-old male presented with complaints of vertigo, bilateral upper limb cramps on physical activity. On examination, pulses were absent bilaterally in upper limbs. On CT angiography brachiocephalic and left subclavian arteries were not visualized. Inflammatory markers were not raised to the extent indicating a very aggressive disease. The patient was not meeting the age limit as described by Ishikawa diagnostic criteria. The patient was referred to the cardiovascular surgery department for revascularization.Keywords: Takayasu arteritis; Ishikawa criteria; Aortic arch syndrome
Ishikawa K. Diagnostic approach and proposed criteria for the clinical diagnosis of Takayasu's arteriopathy. J Am Coll Cardiol 1988;12(4):964–72.
Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE. Takayasu's arteritis. Clinical study of 107 cases. Am Heart J 1977;93(1):94–103.
Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum 1990;33(8):1129–34.
Dabague J, Reyes PA. Takayasu arteritis in Mexico: A 38-year clinical perspective through literature review. Int J Cardiol 1996;54(Suppl):S103–9.
Hall S, Barr W, Lie JT, Stanson AW, Kazmier FJ, Hunder GG, et al. Takayasu arteritis. A study of 32 North American patients. Medicine (Baltimore) 1985;64(2):89–99.
Ishikawa K. Natural history and classification of occlusive thromboaortopathy (Takayasu's disease). Circulation 1978;57(1):27–35.
Weyand CM, Goronzy JJ. Medium- and large-vessel vasculitis. N Engl J Med 2003;349(2):160–9.
Seko Y, Minota S, Kawasaki A, Shinkai Y, Maeda K, Yagita H, et al. Perforin-secreting killer cell infiltration and expression of a 65-kD heat-shock protein in aortic tissue of patients with Takayasu's arteritis. J Clin Invest 1994;93(2):750–8.
Hata A, Numano F. Magnetic resonance imaging of vascular changes in Takayasu arteritis. Int J Cardiol 1995;52(1):45–52.
Yamada I, Numano F, Suzuki S. Takayasu arteritis: evaluation with MR imaging. Radiology 1993;188(1):89–94.
Yamada I, Nakagawa T, Himeno Y, Numano F, Shibuya H. Takayasu arteritis: evaluation of the thoracic aorta with CT angiography. Radiology 1998;209(1):103–9.
Paul JF, Hernigou A, Lefebvre C, Bletry O, Piette JC, Gaux JC, et al. Electron beam CT features of the pulmonary artery in Takayasu's arteritis. AJR Am J Roentgenol 1999;173(1):89–93.
Kissin EY, Merkel PA. Diagnostic imaging in Takayasu arteritis. Curr Opin Rheumatol 2004;16(1):31–7.
Keenan NG, Mason JC, Maceira A, Assomull R, O’Hanlon R, Chan C, et al. Integrated cardiac and vascular assessment in Takayasu arteritis by cardiovascular magnetic resonance. Arthritis Rheum 2009;60(11):3501–9.
Craven A, Robson J, Ponte C, Grayson PC, Suppiah R, Judge A, et al. ACR/EULAR-endorsed study to develop Diagnostic and Classification Criteria for Vasculitis (DCVAS). Clin Exp Nephrol 2013;17(5):619–21.
Luqmani RA, Suppiah R, Grayson PC, Merkel PA, Watts R. Nomenclature and classification of vasculitis - update on the ACR/EULAR diagnosis and classification of vasculitis study (DCVAS). Clin Exp Immunol 2011;164(Suppl 1):11–3.
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