Clinical challenges and multidisciplinary management in Takayasu’s arteritis: a case report

Case presentation: A 43-year-old female patient presented with an ischemic stroke (CVA) in September 2020, resulting in right hemiplegia and aphasia. CT angiography revealed severe bilateral carotid lesions, unusual in extent given hypertension as the only comorbidity. Suspecting Takayasu’s arteritis, we requested ESR, which was elevated, confirming the diagnosis. After starting corticosteroid treatment, ESR levels reduced to 6 mm and are now at 3 mm. The patient is on continuous treatment with prednisone (5mg/day), azathioprine (100mg/day), aspirin (100mg/day), and phenytoin (100mg every 8hours). She reports anxiety and anhedonia. Recent lab results show platelets at 199,000, hemoglobin at 14.9g/dL, LDL at 95mg/dL, and ESR at 3mm. Clinically, she presents with hypertension (BP 137/105mmHg), tachycardia (HR 112bpm), hemiplegic gait, grade 4 paresis, mild spasticity in the right upper limb, hyperreflexia, right-sided hypoesthesia, positive Hoffman sign on the right, and central paralysis of the right seventh cranial nerve. Discussion: This clinical case highlights the complexity of managing a patient with Takayasu’s arteritis, a rare disease affecting large arteries and potentially leading to severe complications like ischemic stroke. The reduction in ESR levels after starting corticosteroids indicates inflammatory control. However, significant stroke sequelae persist, including hemiplegia, aphasia, and neurological signs (hyperreflexia, hypoesthesia, and Hoffman sign), while hypertension and tachycardia require careful management to prevent further complications. Treatment includes prednisone and azathioprine as immunosuppressants, aspirin for thromboembolic event prevention, and phenytoin for seizure prevention. Anxiety and anhedonia underscore the importance of psychological support, making a multidisciplinary approach essential. Final comments: This case underscores the complexity of Takayasu’s arteritis. The multidisciplinary therapeutic approach has proven effective in reducing inflammatory markers and stabilizing the patient clinically. However, neurological sequelae persist, impacting the patient’s quality of life and functional capacity, highlighting the importance of early diagnosis. Thus, it is crucial to identify the disease before complications arise and to conduct longitudinal studies on the progression of Takayasu’s arteritis in patients treated with different therapeutic regimens to determine long-term efficacy and side effects. Sharing this clinical experience aims to enhance the understanding of Takayasu’s arteritis and serve as a tool for students and healthcare professionals.