A Case of unusual presentation of Takayasu's Arteritis with Rheumatic Heart Disease

Abstract

Abstract: Takayasu's arteritis is a chronic inflammatory disease of the large and medium-sized arteries. It commonly involves the aorta with its branches and the pulmonary arteries. Clinically, pulsations were absent in the involved vessels- most commonly in the subclavian artery followed by common carotid and abdominal aorta, renal artery in majority of cases. The high prevalence rates of the disease is reported from Asian countries especially in Japan, India, Korea, and ThailandWe present a 26 yrs. married female presenting with complaints of dyspnea, Paroxysmal nocturnal dyspnoea anda pitting oedema over both legs since 8 monthsat the time of presentation. She had a past history of hemiparesis on right side about a year back which completely recovered over 4-6 hrs. On obstetrics history she had multiple spontaneous abortions(n=3) in third trimester with a preterm delivery 6 months back. On examination all pulse on right side were absent barring weaker, low volumed femoral and carotid arteries.High blood pressure (200+10 and 100+10) was recorded in left brachial artery. Cardiac examination showed systolic murmur in all 4 areas. On investigation, all routine investigations were normal except a raised ESR(104). 2D echo showed severe MR/TR/PAH and moderate MS/AR(probably of a rheumatic origin). To substantiate the diagnosis of a Antiphospholipid syndrome, APLA and ANA tests were done which were negative.A CT angiography of aortic root, its branches and abdominal aorta documentingocclusions of right subclavian artery,abdominal aorta, right femoral artery and bilateral renal artery.The relative lees frequently seen combination of Rheumatic heart disease in the face of a Takayasu’s arteritis is presented hereby for its uncommon occurrence.