Sustained Tocilizumab and Adjunctive HydroBox Therapy in Refractory Takayasu Arteritis: An 11-year Case Report

BACKGROUND/AIM: Takayasu arteritis (TAK) is a rare, chronic granulomatous large-vessel vasculitis predominantly affecting young women, characterized by progressive stenosis and occlusion of the aorta and its major branches. Despite advances in biologic therapy, refractory disease with recurrent vascular complications remains a significant clinical challenge. Molecular hydrogen-based adjuvant (HydroBox) therapy has emerged as a promising adjuvant approach owing to its antioxidant and immunomodulatory properties. This report aims to describe the long-term clinical course and therapeutic outcomes of a patient with refractory TAK managed with sustained tocilizumab and HydroBox-assisted immunomodulatory therapy over 11 years. CASE REPORT: We report the case of a 25-year-old female with refractory TAK first diagnosed at age 13, presenting with sudden vision loss, dizziness, and pulseless upper extremities. Disease course was complicated by extensive great-vessel involvement, multiple cerebral infarctions, and recurrent in-stent restenosis despite ongoing interleukin-6 (IL-6) blockade. Over 50 courses of tocilizumab (Actemra) were administered from 2014 onward, combined with multiple percutaneous transluminal angioplasty and stenting procedures. HydroBox-assisted immunomodulatory therapy was subsequently introduced as an adjunctive treatment. During continued follow-up, the patient remained clinically stable with sustained suppression of inflammatory markers and favorable cerebrovascular findings on serial imaging. CONCLUSION: This 11-year case report documents the feasibility of sustained long-term tocilizumab therapy combined with adjunctive HydroBox therapy in a patient with refractory TAK. Despite extensive multi-vessel involvement, recurrent in-stent restenosis, and prior cerebrovascular ischemia, the patient achieved progressive hemodynamic stabilization, durable suppression of inflammatory markers, and continued disease control. The potential immunomodulatory and antioxidant properties of HydroBox-assisted therapy warrant further prospective investigation to establish standardized protocols and confirm efficacy in larger cohorts.