Takayasu’s arteritis presenting with renal atrophy and nonpulselessness

Abstract

Takayasu's arteritis (TA) is a chronic systemic inflammatory disease that usually affects the aorta, its primary branches and occasionally the pulmonary and coronary arteries. During the past decade, we have noted 12 cases with 1 male and 11 females. Almost had an absent or diminished upper body pulse and a pulse pressure difference of 30 mmHg or more between their two arms. However, in 1998, we noted an unusual case presenting with a right small kidney and non- pulselessness.We report the case of a 22 - year-old woman with Takayasu's disease who developed symptoms of dizziness, headaches, nausea and vomiting, abdominal pain, weight loss, fatigue and arthralgias. Examination noted carotid artery tenderness; bruits over left common carotid artery and abdominal aorta, systemic arterial hypertension with a substantial difference in systolic blood pressure between the left and right arm and normal peripheral pulse. Blood analyze showed a mild anemia and elevated erythrocyte sedimentation rate. Electrocardiogram registered a left ventricular hypertrophy. Diagnosis was performed on the basis of typical arteriographic by magnetic resonance angiography (MRA) and ultrasonic Doppler graphic with the stenotic lesions of left mid common carotid, right renal artery and abdominal aorta. The size of the kidney with renal artery stenosis was diminished notably (diameter of right kidney: 36-47 mm versus diameter of left kidney: 94-66mm on the echography). Patient has fulfilled the American College of Rheumatology (ACR) criteria and Ishikawa criteria. New classification of angiogram in TA is type I and IV + C (-) P (-). With steroid therapy and cyclophosphamides has been successful in stable improving symptoms for 4 years follow-up. A review of the literature is included. In hypertensive young female with unclear symptoms and laboratory findings of generalized inflammation. Need to examine a complete pulse-status, bruits of peripheral arteries and blood pressure measuring at both arms can lead to the right diagnosis of TA. MRA and sonographic can be used to help established the accurate diagnosis as well as the follow-up for an appropriate treatment.