Successful treatment of Takayasu’s arteritis in a HIV positive adult patient with long term follow up

Abstract

Although vasculitides occur in patients with HIV, only 4 previous cases of Takayasu’s arteritis (TA) have been reported in HIVpatients. We describe the first case of TA in an HIV positive patient with successful treatment and long term follow up. A38-year-old woman who was HIV positive for the last 5 years on antiretroviral medications presented with increasing pain in herleft arm. Blood pressure and pulse were unrecordable in that arm. Laboratory testing revealed hemoglobin 7.9 g/dl, CRP 98.8 mg/L, CD4 675 cells/μl and HIV viral load < 48 copies/ml. Both MRA and standard angiography demonstrated occlusion of theleft subclavian artery from its origin to the vertebral artery where it was reconstituted via retrograde flow from the left vertebralartery and left carotid artery branches (subclavian steal). Narrowing of the vertebral artery was also noted. Treatment withprednisone and methotrexate for one year improved her symptoms and stabilized her lesions without infectious complications. Follow up 4 years after stopping therapy revealed mild symptoms and stable lesions on MRA.