Takayasu Arteritis in a 15-Year-Old Male Presenting with Constitutional Symptoms and Upper Limb Pulse Deficit: A Case...

Takayasu arteritis (TA) is a chronic granulomatous large-vessel vasculitis that primarily affects the aorta and its major branches. It is rare in children and adolescents, often leading to diagnostic delays due to its nonspecific initial symptoms such as fever, fatigue, and arthralgia.

We report a 15-year-old male who presented with a several-month history of low-grade fever, easy fatigability, and progressive bilateral multiple joint pain. Notably, he had a history of BCG vaccination and no known tuberculosis exposure. Three weeks prior to diagnosis, he developed chest pain, vomiting, and significant weight loss. Physical examination was notable for absence of left radial and brachial pulses, The right arm blood pressure was 130/87 mmHg despite stable vital signs and unremarkable cardiac auscultation. Initial laboratory findings revealed normocytic anemia (hemoglobin 12 g/dL), elevated erythrocyte sedimentation rate (70 mm/hr), negative rheumatoid factor, and normal renal function. Echocardiography was normal. Computed tomography angiography (CTA) of the abdominal aorta demonstrated concentric arterial wall thickening of the superior mesenteric artery (SMA) with severe stenosis and collateral formation. CTA of the left upper limb revealed long-segment concentric thickening involving the left common carotid, subclavian, axillary, and proximal brachial arteries, Renal arteries were spared with focal occlusion of the brachial artery and distal collaterals. A diagnosis of Takayasu arteritis was made. The patient was initiated on prednisolone 60 mg daily (maximum dose) and methotrexate. Follow-up was arranged for one month.

This case highlights a novel diagnostic pathway in a resource-limited setting, where a high index of clinical suspicion and meticulous physical examination-specifically bilateral pulse palpation-bridged the gap left by a lack of specialized rheumatology services. It demonstrates that even without advanced imaging like PET or MRA, timely diagnosis and intervention are possible in developing healthcare systems.