Takayasu Arteritis Presenting with Upper Limb Weakness and Subclavian Artery Thrombosis in a Young Female: A Case Report

Abstract

Takayasu arteritis is a rare, chronic granulomatous large-vessel vasculitis that primarily affects young women and involves the aorta and its major branches. Owing to its nonspecific early manifestations, diagnosis is frequently delayed until significant vascular involvement develops. We present the case of a 32-year-old female who presented with sudden onset generalized weakness and breathlessness, along with a one-year history of headache, visual blurring, numbness, and progressive weakness of the upper limbs. On examination, she was hypotensive with asymmetric upper-limb motor power. Laboratory investigations revealed severe microcytic hypochromic anaemia with neutrophilic leukocytosis and thrombocytosis. Two-dimensional echocardiography demonstrated global left ventricular hypokinesia, moderate aortic regurgitation, and mild left ventricular systolic dysfunction. Doppler imaging of the upper-limb arterial system revealed diffuse circumferential wall thickening and significant luminal narrowing of the bilateral carotid and subclavian arteries, along with an echogenic thrombus causing critical stenosis of the right subclavian artery. These findings were consistent with large-vessel arteritis. Based on clinical features and imaging findings, a diagnosis of Takayasu arteritis was established. The patient was managed with high-dose intravenous corticosteroids, anticoagulation and supportive care, following which she was referred to a tertiary cardiac centre for further evaluation and definitive management. This case emphasizes the importance of maintaining a high index of suspicion for Takayasu arteritis in young women presenting with unexplained neurological and cardiovascular symptoms, as early diagnosis and timely immunosuppressive therapy are crucial to prevent disease progression and long-term complications.