Beyond the Pulselessness: A Multifaceted Case of Takayasu Arteritis With Aneurysmal Complications and Extensive Upper Limb Vascular Occlusion in a 40‐Year‐Old Female

Takayasu arteritis, a rare chronic large-vessel vasculitis primarily affecting the aorta and its major branches, poses significant diagnostic and therapeutic challenges due to its heterogeneous manifestations and potential for severe vascular complications. This case report details a 40-year-old female presenting with a 12-month history of right arm pain and restricted movement, ultimately diagnosed with Takayasu arteritis. The patient exhibited hallmark features, including a diminished right radial pulse, blood pressure asymmetry (150/92 mmHg left, 125/80 mmHg right), and mild right arm weakness (4/5 strength). Physical examination of the shoulders revealed limited active range of motion in the right shoulder, with abduction restricted to 90° and external rotation to 30°, likely due to ischemic changes, while the left shoulder showed full range of motion. Laboratory findings confirmed active inflammation, with C-reactive protein (CRP) at 18.4 mg/L and erythrocyte sedimentation rate (ESR) at 45 mm/h, alongside mild anemia (11.5 g/dL) and reactive thrombocytosis (360-410 × 10³/μL). CT angiography revealed thrombotic occlusion of the left vertebral artery (60%-70%), significant narrowing with thin flow in the left common carotid and subclavian arteries, moderate occlusion with reconstituted flow in the left mid and distal brachial and radial arteries, and narrowing in the right ulnar and interosseous arteries. Additionally, a 4.0 cm infrarenal aortic aneurysm was identified, a potentially life-threatening complication. Treatment was initiated with intravenous methylprednisolone (1 g daily for 3 days), transitioning to oral prednisone (50 mg/day), combined with ibuprofen for pain (400 mg as needed, up to 1200 mg daily), amlodipine and nifedipine for hypertension, and esomeprazole for gastric protection. A multidisciplinary approach was emphasized, integrating rheumatology and vascular surgery, with plans for steroid-sparing agents (methotrexate or azathioprine) and serial aneurysm surveillance. This case underscores the complexity of Takayasu arteritis, highlighting the need for comprehensive vascular assessments, tailored immunosuppression, and vigilant monitoring to prevent complications and optimize outcomes.