Asymptomatic hypertension and bilateral renal artery stenosis in Takayasu arteritis

The patient, a 34-year-old woman with no prior systemic disease, presented with fever of unknown origin. Laboratory tests revealed an elevated C-reactive protein level and erythrocyte sedimentation rate. A positron emission tomography scan demonstrated patchy fluorodeoxyglucose uptake at the aortic arch (SUVmax 2.8) maximum standardized uptake value, consistent with inflammatory cell infiltration in large-vessel vasculitis (A, arrow). She was diagnosed with Takayasu arteritis and started on immunosuppressive therapy. Subsequently, she developed asymptomatic severe hypertension, with systolic blood pressure exceeding 200 mm Hg. A computed tomography angiography scan revealed mural thickening of the descending aorta (B, arrow), and a “double ring sign” was observed on the venous phase of the scan, defined as concentric mural enhancement of the arterial wall reflecting inflammation, as previously described1 (C, arrow). Contrast-enhanced magnetic resonance angiography (MRA) using a gadolinium chelate and three-dimensional T1-weighted volumetric acquisition demonstrated wall thickening of the abdominal aorta and focal stenosis at the bilateral renal artery origins (D and E, arrow). A reformatted MRA image further confirmed significant bilateral renal artery narrowing (F, arrow). Type III Takayasu arteritis involving bilateral renal arteries was diagnosed. Intensified immunosuppression resulted in gradual blood pressure normalization. This case highlights the importance of vascular imaging in detecting occult renal artery stenosis in patients with large-vessel vasculitis and unexplained hypertension. Supported by the National Science and Technology Council of Taiwan (grant 113-2314-B-002-318) and the National Taiwan University Hospital (grants 113-N0054 and 114-O0033). The authors thank the patient for her consent to share this case, and the medical staff involved in her care. Disclosure form. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.