Severe Takayasu Arteritis Complicated by Mesenteric Ischemia

Abstract

Takayasu arteritis (TA) is an idiopathic large vessel vasculitis which occurs mostly in young Asian females. The authors report an atypical presentation of TA in a woman who presented with signs and symptoms of limb claudication and mesenteric ischemia. This case illustrates the potential severity of this disease and the difficulty in its diagnosis and treatment. A 46-year-old Caucasian woman was admitted to the hospital with right lower limb claudication, aroused for small distances, in association to ischemic ipsilateral foot ulcers. She also reported recurrent episodes of abdominal pain, vomiting and diarrhea which leaded to an overall weight loss of 10 kg in a period of a year. Non-invasive vascular testing revealed a right ankle-brachial index of 0.17 and a left ankle-brachial index of 0.37. The abdominal aortography and the computed tomography (CT) angiography showed an occlusion of the superior mesenteric artery and irregularities of the aortic lumen. Oclusions in the right internal iliac artery and in the distal common femoral artery were found in the pelvic aortography. Lower limbs arteriography revealed multiple stenoses. The histological result from the femoral endarterectomy was consistent with large vessel vasculitis. The diagnosis of TA was established according to the American College of Rheumatology Criteria, based on the patient’s symptoms, physical and imaging findings. Despite aggressive immunosuppressive therapy with prednisolone and infliximab, an atypical refractory massive mesenteric ischemia occurred, leading to patient’s death. TA is a rare disease with variable presentation. Since this disease is associated with high morbidity and mortality, an early diagnosis is essential for the best prognosis. Critical mesenteric ischemia and peripheral limb ulcers are rare presentations. As mesenteric ischemia can be potentially fatal, early aggressive immunosuppressive therapy and resection of the affected bowel segment are usually required. J Med Cases. 2017;8(12):383-387 doi: https://doi.org/10.14740/jmc2945w