A 50-Year Delay in the Diagnosis of Takayasu Arteritis: Clinical Presentation and Therapeutic Insights.

Takayasu arteritis (TAK) is a rare inflammatory disease that affects large blood vessels, primarily targeting the aorta and its major branches. However, its etiology remains unknown. Although TAK is reported worldwide, it has a higher prevalence among women of Asian descent. Here, we report a rare case of TAK diagnosed 50 years after the onset of initial symptoms in a 76-year-old Japanese woman. The patient initially experienced numbness in her left upper extremities, followed by loss of consciousness. She had occasionally experienced difficulties with blood pressure measurements during routine medical examinations since the age of 20 years. Several months before admission, she had experienced visual darkening during physical activity and orthostatic dizziness that resolved with recumbency. Laboratory test results, including complete blood count, liver and renal function, C-reactive protein levels, and electrolyte levels, were within the normal limits. Computed tomography angiography (CTA) revealed stenosis of the bilateral subclavian arteries and the left common and internal carotid arteries, along with prominent collateral circulation, suggesting TAK. Given the substantial risk associated with corticosteroid-based therapy, we initiated treatment with aspirin and atorvastatin. After discharge, infliximab was started at 200 mg for three doses and then increased to a dose of 300 mg (5 mg/kg) every six weeks. Orthostatic symptoms markedly improved after the sixth infusion. Dizziness did not worsen during follow-up. Annual follow-up CTA and carotid ultrasonography showed no arterial stenosis progression.  This case report reveals that despite normal inflammatory marker levels, vascular stenosis of the carotid and subclavian arteries may cause dizziness that can be improved with infliximab therapy. Cases of TAK with marked progression despite normal inflammatory marker levels have been reported. Although the reversibility of vascular stenosis remains uncertain, infliximab therapy considerably improved dizziness and orthostatic symptoms. In patients with unexplained dizziness and orthostatic symptoms, large-vessel vasculitis, such as TAK, should be considered in the differential diagnosis, even in the absence of elevated inflammatory markers.