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.