Naiim Mousavi

Naiim Mousavi

Takyasu Case

The patient is a 19- year- old Iranian boy from the south provinces and Arab race , known case of Takayasu disease from 1998 .

It all started 2 years ago when his severe headache and lightheadedness together with some visual disturbances( blurred vision ) brought him into the physicians attention when his abnormally high blood pressures (right hand 260 /120 and left hand 180 /100 ) were detected .

Routine lab data disclosed no specific finding except his WBC profile which revealed 45 & 55% for Neut . & Lymph. respectively .

His ESR was 10 and RF was negative . Urine creatinine level was 1.2 gr/24 hrs. (1510 total urine vol. ) . CXR revealed no rib notching .Echo . only showed mild MR and captopril DTPA , renal scans , & VMA of 24 hrs.

Urine were normal . However angiography of great vessels disclosed.

1. Bilateral proximal renal artery stenosis ( 60% in the right & 70 % in the left ) .

2. complete occlusion of left subclavian artery ,passing the branching of thyrocervical , vertebral & int. mammary .

The patient underwent medical therapy with prednisolone but hypersensitivity reaction cut it off and later since the acute phase had stopped no immunosuppressive drugs were suggested for the patient . His high blood pressure didn’t respond well to SL nifidipine, furosemide , prazosin , captopril and atenolol. So vascular surgery was performed to correct the stenosis in March 2000 .

After bilateral aorto renal bypass his BP again raised and even once reached 260/110 . U/A showed 65 mg/dl & 10 mg/dl proteinuria nearly 6 & 9 month offer surgery respectively. and WBC profile returned to normal. Now still high BPs ( Right : SBP =230, Left : SBP=195 ) are his problem and latest renal sonography showed normal corticomedullary thickness in both kidneys , the size of right kidney was 120 mm and the size of left kidney was 102 mm. He is now candidate for other vascular surgical repair for his BP.