A 27-year-old woman presents with six months of claudication in both forearms, dizziness on standing, and low-grade fever. Her right radial pulse is impalpable, the left is diminished, and systolic blood pressure differs by 28 mmHg between the arms. A bruit is audible over the left carotid artery. ESR is 74 mm/hr. Angiography shows smooth narrowing of the subclavian arteries bilaterally and stenosis of the left common carotid artery. What is the most likely diagnosis?

• A Polyarteritis nodosa
• B Giant cell (temporal) arteritis
• C Takayasu arteritis ✓
• D Thromboangiitis obliterans (Buerger disease)

Explanation

Takayasu arteritis is a granulomatous large-vessel vasculitis of the aorta and its major branches, affecting women under 40, particularly of Asian descent. Upper limb claudication, asymmetric or absent pulses, inter-arm blood pressure difference above 10 mmHg, carotid or subclavian bruits, and raised inflammatory markers are classic. Giant cell arteritis produces identical vascular pathology but occurs almost exclusively after age 50, while Buerger disease involves distal extremity vessels in young smokers and PAN affects medium-sized visceral arteries.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.