Takayasu Arteritis (TA) is a rare large vessel granulomatous vasculitis involving the aorta and its branches. There is a strong female preponderance, with females comprising 75%-97% of cases1,2. We present a case series of two Caucasian males with TA in Regina, Saskatchewan.
The first patient was a 33-year-old Caucasian male who presented in a hypertensive urgency, with chest pain and a blood pressure (BP) of 210/110 mmHg (with a discrepancy of 20mmHg between arms). Bruits were auscultated in bilateral subclavian and renal arteries. CT angiography (CTA) showed diffuse arterial narrowings, with bilateral renal artery stenosis of over 90%, supporting the diagnosis of TA. He underwent successful bilateral renal artery angioplasty and stenting for refractory hypertension, though re-presented seven months later with lower extremity claudication. He subsequently underwent aorto-bifemoral bypass, but suffered a left renal artery occlusion. Attempts at an aortorenal bypass and re-cannulation of the occluded left renal artery was unsuccessful, and the patient ultimately succumbed to his illness post-operatively.
The second patient is a 45-year-old Caucasian male admitted with pleuritic chest pain. BPs were 195/119 mmHg and 174/90 mmHg on the right and left arms respectively. Brachial and radial pulses were noticeably weaker on the left. C-reactive protein and erythrocyte sedimentation rate were elevated at 49.9 mg/L and 25 mm/hr, respectively. CTA showed diffuse thickening of the aorta, with high grade narrowing in the left renal artery, confirming the diagnosis of TA. Echocardiogram showed a small pericardial effusion, suggestive of concurrent pericarditis. He was initiated on ramipril and colchicine in-hospital, and was discharged home on prednisone, with a 4-week follow-up scheduled.
TA remains a rare systemic inflammatory disease, particularly in males. Its constellation of non-specific symptoms presents a diagnostic dilemma. A high level of suspicion is required for prompt diagnosis and initiation of therapy.