A case of pediatric Takayasu arteritis with symptoms of headache, absent of wrist pulses, and absence of fever

Abstract

We report the case of a 13-year-old girl with Takayasu arteritis who presented with a headache and loss of pulse without fever. At the age of 10 years, she developed a headache with visual field narrowing. At the age of 13 years, she was referred to our hospital because her blood pressure could not be measured in her right upper arm and there was no pulse in the right radial artery. Cervical echocardiography showed 98% stenosis of the right common carotid artery. Contrast-enhanced Computed Tomography(CT) of the head to pelvis showed circumferential wall thickening and increased periprosthetic fatty tissue density from the aortic arch to the proximal portion of the descending aorta, bilateral subclavian, and bilateral common carotid arteries. Positron Emission Tomography/CT showed increased wall thickening of the brachiocephalic artery, both common carotid arteries, and both subclavian arteries from the aortic arch. She was diagnosed with Takayasu arteritis with a type IIB vascular involvement pattern and treated with steroids, azathioprine, and tocilizumab. Her headache gradually decreased and blood pressure in the right upper arm became measurable. In pediatric patients with Takayasu arteritis who do not present with fever, the syndrome should be suspected based on other nonspecific symptoms. Furthermore, aggressive imaging and other diagnostic procedures should be initiated when a left-right difference in blood pressure or absent of wrist pulses is observed.