figure
4.D) CT angiogram sagittal view shows marked wall thickness with
enhancement at the left subclavian artery (SCA) (white arrow).
While the vasculitis screen returned negative, the CT angiogram findings
suggest large vessel vasculitis, specifically Takayasu arteritis.
Management commenced with Prednisone (1mg/kg QD) and methotrexate 10mg
per week as induction, alongside metoprolol 100mg QD and Lisinopril 10
mg QD. However, no notable improvement in the patient’s condition was
observed after three months. During the follow-up, the patient developed
recurrent attacks of fever, myalgia, and frequently had elevated
inflammatory markers. This condition was labelled as a flare-up under
rheumatologist supervision. Medication changes were implemented, and the
patient was kept on prednisone 20 mg QD, leflunomide 20mg QD, colchicine
1mg BD, and adalimumab 40mg subcutaneous Q 2wk for 3 months, leading to
clinical and laboratory improvement. After that, scheduled prednisone
tapering was initiated until reaching 7.5 mg QD.
The patient’s condition remained stable throughout the follow-up period,
with consistent improvement observed in serial ECGs (Figure 5) and
normal echocardiograms during monthly visits to our cardiology
outpatient clinic.