A case of early Takayasu's arteritis with initial symptoms of carotidynia and fever

Abstract

We report herein on a 15-year-old girl with Takayasu's arteritis (TA) in the early pre-pulseless phase who presented with left neck pain and fever. laboratory examination revealed a high level of C-reactive protein (CRP) and an elevated erythrocyte sedimentation rate (ESR). Findings of ultrasonography, computed tomography (CT), and magnetic resonance imaging and angiography (MRI, MRA) demonstrated a thickening of the left carotid artery but neither stenosis nor dilation of the large vessels. 18 F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) after twenty days duration of fever revealed an accumulation of 18 F-fluorodeoxyglucose not only in the left carotid artery but also the wall of the ascending aorta, aortic arch, thoratic aorta, and part of abdominal aorta, which led to the diagnosis of TA in the early pre-pulseless phase. The patient was treated with prednisolone resulting in a marked improvement in both the clinical symptoms and laboratory parameters within a couple of weeks. Stenosis of the left carotid artery was found in MRI, MRA following four months and a definitive diagnosis was reached. We suggest early diagnosis of TA may permit early treatment and improve the prognosis.