CASE REPORT
A 29y old female G4P3L2A0 of 40weeks of gestational age came for safe
confinement in our hospital and was admitted to Obstetrics and
gynecology department. She underwent emergency lower segment caesarean
section (LSCS) because of severe oligohydramnios (Amniotic Fluid
Index<3cm), the baby and mother were in good health. She was
taken over to the Department of Internal Medicine for further evaluation
in view of the absent bilateral radial pulse, Blood pressure (BP) not
recordable in both upper limbs. On examination, she is well built, with
no pallor, icterus, clubbing, cyanosis, or pedal edema. On physical
examination bilateral upper limb radial, brachial pulse not palpable,
and BP not recordable. Bilateral carotid bruit present. Lower limb left
dorsalis pedis pulse was not palpable and BP recordings were
(right-110/80 and left-120/80). This case report has been reported in
line with SCARE criteria.
Her Ultrasonography (USG) carotid doppler showed left common carotid
artery diffuse circumferential narrowing (60%) and lower limb doppler
showed “macaroni sign” (Fig.1). CT (Computed Tomography) aortogram
showed right distal two-third and left diffuse common carotid artery
(Fig.2(a)), bilateral subclavian (Fig.2(b)), and infrarenal abdominal
aorta, superior mesenteric, left common iliac artery circumferential
narrowing without an aneurysm (Fig.2(c)). Electrocardiogram (ECG) was
normal and 2D-Echo was normal with adequate Left Ventricle function.
Laboratory findings showed elevated erythrocyte sedimentation rate
(Erythrocyte Sedimentation Rate 130mm/hour) and C-reactive protein level
was 20mg/dl at the time of admission. Considering these findings, the
diagnosis was made as Takayasu Arteritis (type V).
The patient was started with Tab Prednisolone therapy at 50mg/day and
followed up on the case regularly. In the subsequent visits, the steroid
dose was tapered and tab. Tablet Aspirin 75mg was added as secondary
prophylaxis for coronary artery disease. Eventually steroid was tapered
and tablet Azathioprine 50mg twice daily was added.