From transient ischemic attack to peripheral vascular disease: a multifactorial case requiring steroid therapy

A 70-year-old male from Himachal Pradesh, India, initially presented with two episodes of transient loss of consciousness and persistent temporal headache. He was diagnosed with transient ischemic attack (TIA) and temporal arteritis, which responded well to steroid therapy. One year later, he experienced weight loss and developed axillary lymphadenopathy (LAD), with histopathological and CBNAAT confirmation of extrapulmonary tuberculosis (TB). He underwent a six-month course of anti-tubercular treatment (ATT). However, six months’ post-treatment, he developed vascular claudication of the left lower limb and severe left iliac region pain, which dramatically responded to steroid therapy. Computed tomography (CT) angiography revealed peripheral vascular disease (PVD), and CT enterography showed abdominal LAD, leading to the re-initiation of ATT alongside steroids. This case underscores the importance of steroids in managing complex, multifactorial conditions and highlights the necessity of a multidisciplinary approach for optimal patient outcomes.