Vasculitis

A 17-year-old girl presented with a history of a month of fever with headache, reduced appetite, and weight loss. There were no localizing symptoms. On examination, she was pale, but otherwise, no focus of infection or markers of connective tissue disease was evident, and systemic examination was normal. Her vital signs and initial blood pressure, recorded using an automated machine, were normal (100/60 mmHg in the left arm). The initial investigations showed a raised erythrocyte sedimentation rate (ESR) but no other clue as to the cause of the fever. When no diagnosis could be made from the initial evaluation, the child was re-examined. This time the blood pressure was recorded manually. In the right arm, it was noted to be 148/90 mmHg. On careful examination of her pulses, the left brachial and radial pulses were noted to be significantly weaker than the right. In view of the hypertension noted in the right upper limb, the difference in the four-limb blood pressures, and the difficulty in palpating the left radial and brachial pulses, a clinical diagnosis of Takayasu arteritis was made. This was confirmed by arteriography, and the child responded well to treatment.