Results and follow up
A decision was made to continue the tuberculosis regimen and pursue
further evaluation. Tuberculosis of the spine was considered, and an MRI
of the spine returned normal results.
Serial blood tests, including a complete blood count (CBC), syphilis
screen, thyroid function test, and autoimmune workup – which included
testing for antinuclear antibodies, double-stranded DNA,
antineutrophilic cytoplasmic antibody, rheumatoid factor, cryoglobulin
panel, and antiphospholipid antibodies – yielded negative. However, an
elevated erythrocyte sedimentation rate (ESR) of 100 mm/hr was observed.
Despite the negative immune screening, the persistent elevation in ESR
prompted further investigation into potential underlying causes for the
increased inflammatory marker.
Further assessment indicated a difference in blood pressure between the
left arm (110/70 mmHg) and right arm (160/95 mmHg), leading to a CT
angiogram that confirmed large vessel vasculitis with aortic enhancement
(Figure 4 A, B, C, D). Additionally, mild aortic regurgitation and trace
pericardial effusion were observed on echocardiography.