Takayasu retinopathy unveiling underlying Takayasu arteritis: a case report

Area of Science:

• Ophthalmology
• Vascular Medicine
• Rheumatology

Background:

• Takayasu arteritis (TAK) is a rare large-vessel vasculitis affecting the aorta and its branches.
• Ocular involvement in TAK, including Takayasu retinopathy (TR), results from ischemia and can be an early sign.
• Early diagnosis of TAK is critical, as ocular symptoms may be the initial presentation.

Purpose of the Study:

• To highlight decreased vision as a primary manifestation of Takayasu arteritis.
• To emphasize the importance of recognizing ocular signs alongside systemic symptoms for early TAK diagnosis.
• To discuss the management of advanced Takayasu retinopathy in the context of systemic vasculitis.

Main Methods:

• Case report of a 29-year-old male with progressive vision loss.
• Ocular examination including fundus fluorescein angiography and OCT angiography.
• Vascular imaging (Carotid Doppler, CT angiography) to assess aortic arch involvement.
• Laboratory tests including C-reactive protein and anti-nuclear antibodies.

Main Results:

• The patient presented with nine months of progressive blurred vision, syncope, and upper limb claudication.
• Ocular findings included microaneurysms, a type 3 arteriovenous anastomosis, and significant capillary nonperfusion.
• Vascular imaging revealed near-total occlusion of major aortic arch branches, consistent with advanced TAK.
• Diagnosis of TAK with stage 4 Takayasu retinopathy was confirmed.

Conclusions:

• Decreased vision can be the initial and predominant symptom of Takayasu arteritis.
• Advanced Takayasu retinopathy with specific vascular anomalies indicates severe, chronic ischemia.
• Integrating ocular findings with systemic symptoms like claudication is vital for timely TAK diagnosis.
• Systemic immunosuppression and ocular interventions can preserve vision and prevent further complications.