Arteritis of Takayasu in Western man of 31 years

Abstract

We present the case of a 31-year-old Caucasian male, which was being studied in the emergency department for two episodes of syncope. The patient had a history of pain, coldness and paraesthesia of the right arm, jaw claudication, and intense headaches. He was being treated with two antihypertensive drugs due to arterial hypertension. Physical examination showed a differential arterial blood pressure between the arms (right 95/40, left 170/100), carotid systolic murmur in both sides of the neck, both supraclavicular spaces, and mesogastrium as well. Carotid and radial arteries pulses amplitude was diminished. Doppler sonography revealed several lesions in different vascular territories so the patient was sent for magnetic resonance angiography and a computed tomography angiography, revealing obstructions in the brachiocephalic artery, subclavian and vertebral arteries of both vascular territories which are marked with arrows (Panel A). Panel B shows that the carotid arteries are supplied by circulatory collateral through the polygon of Willis. The descending aorta was not affected (Panel C), but the right renal artery and the lower renal lobe the arteries had severe obstructions (Panel D). The wall of the aortic arch marked with an arrow shows an increase in thickness due to inflammation (Panel E). After several tests patient was diagnosed of Takayasu arteritis. He was treated with corticosteroids and percutaneous peripheral arteries interventions with good result and excellent clinical outcome. We report this case because the uncommon nature of Takayasu arteritis in western men, and its extensive vascular damage.