Takayasu Arteritis with Recurrent Acute Limb Ischemia

Vol V Issue V
DOI: 10.5083ejcm20424884.165 , Cite or Link Using DOI
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Joan Dymphna P Reaño, Julie Ann Stephanie Miralles-Amora, Karen V. Miralles, Maria Grethel C. Dimalala,Elaine B. Alajar, Geraldine T. Zamora, Agustina D. Abelardo, Anthony C. Leachon, Rafael R. Castillo,

ABSTRACT Takayasu arteritis (TA) is a rare, systemic; large- vessel vasculitis that usually involves women of child-bearing age, causing severe vascular extremity ischemia that may necessitate revascularization. We report a case of 29-year- old female, who presented with sudden right leg pain, accompanied by paresthesia, poikilothermia, pallor, and pulselessness of the lower extremities. There was a past history of ischemic stroke at the age of 25 years and one-year history of bilateral leg claudication. Computed tomographic angiography revealed thrombus in the infrarenal abdominal aorta with segmental occlusion of the right mid- to distal external iliac artery, complete occlusion of the right common femoral artery with distal collateral blood flow from the right inferior epigastric artery, and complete occlusion of the left common iliac artery with distal collateral blood flow from the left inferior epigastric artery. Surgical thrombo-embolectomy was attempted but failed due to fibrotic femoral artery. Histopathology of the arterial plaque showed findings consistent with an acute- phase, on top of a chronic-phase of TA. Despite aggressive medical therapy, she developed recurrent limb ischemia and likely mesenteric ischemia. Infusion of infliximab, a tumor necrosis factor inhibitor, was initiated on top of steroids, methotrexate, and anticoagulation, resulting in symptom control and remarkable clinical improvement.