Hong Wu, MD, Medical College of WIsconsin, Milwaukee, WY, USA and Amarjit Virdi, MD, Medical College of Wisconsin, Milwaukee, WI, Albania.
We reported an unusual presentation of chronic, intractable abdominal pain in a 42 year old African American female. The non-specific symptoms led to an extensive evaluation involving multiple abdominal surgeries over twenty years. Finally, Takayasu' arteritis was diagnosed based on the patient' clinical features and imaging studies in addition to the exclusion of other possible abdominal pathologies. Of interest in this case is that there is no visible abnormality of celiac and mesenteric vasculature found by magnetic resonance angiography (MRA). The patient' chronic, intractable abdominal pain is likely secondary to the mesenteric ischemia caused by possible vasospasm of the intestinal vasculature, reduced blood flow in the intestine during eating, and/or referred pain from the surrounding ischemic structures. High dose prednisone along with methotrexate resulted in a complete relief of her abdominal pain. Early suspicion and diagnosis for such a condition would reduce the cost of health care, and avoid some invasive interventions.
References: 1. Arend WP, Michel BA, Bloch DA, Hunter GG, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RV, Lie JT, lightfoot RW Jr, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu Arteritis. Arthritis Rheum 1990;33 (8):1129-1134.
2. Chang JB, Stein TA. Mesenteric ischemia: acute and chronic. Ann Vasc Surg 2003;17(3):323-8.
3. Hoffman GS, Leavitt RY, Kerr GS, Rottom M, Sneller MC, Fauci AS. Treatment of glucocorticoid-resistant or relapsing Takayasu's arteritis with methotrexate. Arthritis Rheum 1994; 37:578-582.
Funding: None
Hong Wu, MD
Nothing to disclose.
