A 40-year-old woman presents with hypertension, diminished upper extremity pulses, fever, and elevated ESR. Aortic arch angiography shows irregular stenosis of the aorta and its major branches. Biopsy shows panarteritis with multinucleated giant cells and inflammatory infiltrate in the outer media and adventitia. The diagnosis is:

• A Takayasu arteritis — affecting aorta and major branches in young women ✓
• B Giant cell (temporal) arteritis — affecting temporal arteries in elderly
• C Polyarteritis nodosa — affecting medium-sized arteries with fibrinoid necrosis
• D Kawasaki disease — affecting coronary arteries in children

Explanation

Takayasu arteritis (pulseless disease) is a granulomatous vasculitis of large vessels (aorta and its major branches) predominantly affecting women under 40, particularly in East Asia. Pathology shows panarteritis with transmural inflammation, granulomas, and giant cells most pronounced in the outer media and adventitia, leading to progressive fibrous thickening and luminal narrowing. The classic presentation is 'pulseless disease' with absent upper limb pulses, hypertension from renal artery stenosis, and systemic inflammation. Giant cell arteritis affects temporal arteries in patients >50 years old with similar histology but different distribution.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.