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iatroX Rounds #51

Thursday, 13 August 2026·Rheumatologyhard

The clues

  1. 1

    A 26-year-old woman presents with persistent fatigue, malaise and occasional episodes of lightheadedness when standing.

  2. 2

    She reports an aching sensation in her arms that develops during repetitive tasks, such as blow-drying her hair or hanging laundry.

  3. 3

    Over the previous six months, she has experienced intermittent night sweats, joint pains and an unintentional weight loss of 5 kg.

  4. 4

    On examination, the radial pulses are very weak bilaterally, and a systolic bruit is audible over the carotid and subclavian arteries.

  5. 5

    There is a systolic blood pressure discrepancy of 30 mmHg between the arms, and the ESR is significantly raised at 82 mm/hr.

  6. 6

    CT angiography reveals concentric wall thickening of the aortic arch and smooth, long-segment stenosis of the brachiocephalic trunk.

the diagnosis
Takayasu arteritis

<p><strong>Takayasu arteritis</strong> is a chronic, large-vessel granulomatous vasculitis that primarily involves the aorta and its major branches. It is classically seen in women under 40 years of age and progresses from an initial inflammatory phase to a late 'pulseless' phase.</p>

  • <strong>Constitutional symptoms</strong> such as fever, night sweats and weight loss are common in the early phase
  • <strong>Limb claudication</strong> occurs due to stenosis of the subclavian or iliac arteries
  • <strong>Absent or weak peripheral pulses</strong> are found in the majority of patients
  • <strong>Blood pressure discrepancies</strong> of more than 10 mmHg between the arms is a key diagnostic criterion
pearl. <p>The combination of <strong>constitutional symptoms</strong> and <strong>pulseless limbs</strong> in a young woman is the most characteristic clinical picture of this condition.</p>

more Rheumatology rounds

A 30-year-old man of Turkish descent presents with a one-year history of painful, recurrent ulcers in his mouth that take two weeks to heal.#52A 34-year-old woman presents to her GP with a six-month history of a swollen, painful right index finger and stiffness in her lower back.#43A 32-year-old woman presents with pain and swelling in her left calf following a short domestic flight.#36A 52-year-old woman presents with a three-month history of progressive difficulty rising from a low chair and climbing stairs.#33

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