Amaurosis fugax and an incidental asymptomatic pulselessness are cardinal features of Takayasu arteritis - Case report

Abstract

Background: Takayasu Arteritis (TA) is a rare, chronic large-vessel vasculitis primarily affecting the aorta and its branches. Because the initial phase often presents with non-specific systemic symptoms, early diagnosis remains difficult. Amaurosis fugax (transient monocular visual loss) can serve as a critical sentinel sign of large-vessel involvement, warranting immediate vascular assessment.

Case Presentation: We report the case of a 40-year-old female presenting with a three-month history of recurrent amaurosis fugax in the left eye, exertional dyspnea, and upper limb claudication. Physical examination revealed weak to absent radial pulses and a marked discrepancy in blood pressure between the upper and lower extremities ("pulseless disease"). Initial laboratory investigations revealed only a mild elevation in C-reactive protein (2.11 mg/dL), and a temporal artery biopsy was negative for Giant Cell Arteritis.

Diagnosis and Management: Despite the lack of specific serological markers, CT Angiography (CTA) provided definitive evidence of TA. Imaging demonstrated severe attenuation of the left subclavian artery and diffuse irregular mural thickening of the left common carotid artery. This angiographic pattern differentiated the condition from Fibromuscular Dysplasia. The patient was started on an immunosuppressive regimen comprising prednisolone and methotrexate. At the 20-day follow-up, she reported complete resolution of visual disturbances and claudication.

Conclusion: This case highlights that Takayasu Arteritis should be a primary differential diagnosis in young adults presenting with transient visual loss and pulse deficits. It underscores the necessity of relying on clinical and angiographic evidence for diagnosis, particularly when inflammatory markers are inconclusive and small-vessel biopsies are negative.