Takayasu Arteritis Presenting with Cholesterol Emboli

Abstract

Introduction: Takayasu arteritis is chronic vasculitis involving large vessels. Accelerated atherosclerosis has been docu- mented in patients with Takayasu arteritis.
Case presentation: We have described a 53 year-old Thai woman who presented with 2-weeks history of painful erythema- tous to purplish patches on both soles. She has had hypertension since she was 29 years old and she has diabetes mellitus, dyslipidemia and cerebrovascular disease. Physical examination revealed decreased pulsation of her left brachial artery, difference in systemic blood pressure between both arms and bruit over subclavian arteries and the abdominal aorta. Derma- tologic examination demonstrated multiple discrete ill-defined painful non-blanchable erythematous to violaceous macules and patches on her toes and soles. Some lesions were reticulated blanchable erythematous patches. Ulcer, digital cyanosis and gangrene were found on the tips of her toes. Magnetic resonance angiographic finding of her aorta and its branch was compatible with Takayasu arteritis. Skin biopsy was obtained from the livedo reticularis area of her left foot. The section revealed occlusion of arterioles by cholesterol crystal emboli.
Conclusion: Accelerated atherosclerosis has been reported in patients with Takayasu arteritis. Cholesterol emboli can be a rare presentation from atherosclerosis. Prevention and early recognition for atherosclerotic plaque should be performed in patients with Takayasu arteritis. Moreover, the effective control of traditional atherosclerotic risk factors is needed, in addi- tion to the effective suppression of disease activity, for the management of Takayasu arteritis.