Takayasu arteritis with ASD presenting as sterile corneal me
Published in the Journal of The Association of Physicians of India, the authors present a case of sterile corneal melt in a previously healthy 40 year female with features of Takayasu arteritis with an incidental atrial septal defect.

A 40 year old female initially admitted in ophthalmology ward with history of decreased vision in the right eye for past 1 month, history of pain and redness in the right eye one month back. Ocular examination revealed a sterile corneal melt with iris prolapse in the right eye. She was found to have very low blood pressure and absent pulses in both upper limbs.

On examination of the peripheral pulses, the brachial, radial and ulnar pulses were absent on both upper limbs. She had a carotid thrill with bruit on the right side. The blood pressure in right upper limb was 80/50 mmHg, left upper limb 70/50 mmHg, right lower limb 140/80 mmHg and left lower limb was 150/70 mmHg. There was a wide and fixed second heart sound with ejection systolic murmur of grade 2/6 in pulmonary area.

ECG demonstrated features of right axis deviation with features RV overload. Chest X-Ray was normal. Echocardiography showed dilated Right atrium and ventricle with Atrial septal defect of ostium secondum type left to right shunt with moderate PAH. Arterial Doppler of both upper limbs revealed diffuse wall thickening of both subclavian arteries with high velocity biphasic flow and a low velocity monophasic flow in both axillary and brachial arteries. There was a venous like flow with no pulsatility in both radial and ulnar arteries.

She was diagnosed with Takaysu Artertis Type 1. She was treated with injectable steroids and tectonic keratoplasty was done in the right eye (Figure 5). The vision in the right eye was improved in the postoperative period. The inflammatory markers ESR, CRP has come down with the treatment. She was on oral prednisolone 1mg/kg/day.

Major takeaway:-
- The present case not only presents an unusual ocular presentation of Takayasu arteritis, but it also reiterates the importance of systemic examination in a patient with ocular presentation.

Know more here: http://www.japi.org/january_2019/019_cr_takayasu_arteritis.pdf