Figure 5.follow-up ECG conducted after 6 months, illustrating premature ventricular contractions (PVCs).
Discussion :
Aortitis, characterized by inflammation of the aorta, is a condition with the potential for life-threatening consequences. The diagnostic exploration of aortitis is guided by a differential diagnosis that categorizes causes into inflammatory and infectious origins. The principal contributors to non-infectious aortitis are the large-vessel vasculitis, specifically giant-cell arteritis and Takayasu arteritis, affecting the aorta and its primary branches (6).
Takayasu Arteritis (TA), a rare form of vasculitis, primarily affects large vessels, such as the aorta and its main branches. While classic presentations include limb claudication, reduced or absent pulses, and vascular bruits, TA can also manifest in unusual ways, adding complexity to its diagnosis and management (7).
One of the less common manifestations of TA is renal involvement, which may present as renovascular hypertension due to renal artery stenosis. This can lead to significant morbidity if not recognized and managed promptly (7). Another atypical presentation is neurological symptoms, ranging from headaches and dizziness to more severe complications like strokes or transient ischemic attacks, attributed to the involvement of carotid or vertebral arteries (8).
Gastrointestinal (GI) involvement, although rare, is another unusual manifestation of TA. Patients may experience abdominal pain, ischemic bowel disease, or even acute abdomen, often resulting from mesenteric artery stenosis or aneurysms (9). Pulmonary artery involvement can also occur, leading to symptoms like dyspnoea, chest pain, or haemoptysis.
Cardiac manifestations, including aortic regurgitation, coronary artery disease, and myocardial infarction, are also reported in TA patients, posing significant risks (10).
These atypical manifestations highlight the need for a high index of suspicion and comprehensive evaluation in patients with TA. A multidisciplinary approach involving rheumatologists, cardiologists, neurologists, and other specialists is often necessary for optimal management. Understanding and recognizing these unusual presentations are crucial for early diagnosis and treatment, which can significantly alter the disease course and improve patient outcomes (10).
References :
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  2. Mason, Justin C. “Takayasu arteritis—advances in diagnosis and management.” Nature reviews rheumatology 6.7 (2010): 406-415.
  3. Russo, Ricardo AG, and María M. Katsicas. “Takayasu arteritis.” Frontiers in pediatrics 6 (2018): 265.
  4. Kerr, Gail S., et al. “Takayasu arteritis.” Annals of internal medicine 120.11 (1994): 919-929.
  5. Mwipatayi, Bibombe P., et al. “Takayasu arteritis: clinical features and management: report of 272 cases.” ANZ journal of surgery 75.3 (2005): 110-117.
  6. Gornik HL, Creager MA. Aortitis. Circulation. 2008 Jun 10;117(23):3039-51. doi: 10.1161/CIRCULATIONAHA.107.760686. PMID: 18541754; PMCID: PMC2759760.
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  8. Direskeneli, Haner. “Clinical assessment in Takayasu’s arteritis: major challenges and controversies.” Clin Exp Rheumatol 35.Suppl 103 (2017): 189-93.
  9. Keser, Gökhan, Kenan Aksu, and RAFİ HANER DİRESKENELİ. “Takayasu arteritis: an update.” Turkish journal of medical sciences 48.4 (2018): 681-697.
  10. Schmidt, Jean, et al. “Diagnostic features, treatment, and outcomes of Takayasu arteritis in a US cohort of 126 patients.” Mayo Clinic Proceedings. Vol. 88. No. 8. Elsevier, 2013.
  11. Chatterjee, Soumya, et al. “Clinical diagnosis and management of large vessel vasculitis: Takayasu arteritis.” Current cardiology reports 16 (2014): 1-10.