Takayasu’s arteritis was the cause - A fever gripped a woman every afternoon, only to slide back to normal while she slept
Takayasu’s arteritis caused the condition which affects 1 in about 200,000 people, usually those younger than 40. Ninety percent are female. Takayasu’s arteritis affects the aortic arch, and large arteries branching out of the heart, including those that supply blood to the arms. One of Maryman’s recurring symptoms was arm pain, which had been attributed to the fractures from her fall. The rheumatologist was convinced he was correct when he tried to take her pulse and blood pressure. This impaired blood flow resulted in an old nickname for Takayasu’s: the pulseless disease. Doctor prescribed prednisone, a potent steroid that reduces inflammation, and ordered MRA scans, which provide pictures of the interior of blood vessels, confirmed the diagnosis. The prednisone, which Maryman continues to take — although at a diminishing dose — knocked out the fever and restored much of her energy. But her arms remain affected — she still can’t vacuum — and it is unclear whether some of the damage is permanent.
Case information is given below:
To Carol Maryman, the fever and malaise were worse than an injury she had suffered in July 2012. The fevers started in March 2013, soon after she returned from a trip to Arizona. A hike in the red rock canyons that rim Sedona left her unusually winded and tired, feelings that persisted after she returned home. After a few weeks of night sweats that did not abate, she consulted her primary care doctor. A chest X-ray showed that her lungs were clear, but the doctor thought she detected a heart murmur and sent Maryman to a cardiologist. An ECG found that her heart was normal. But her blood tests were not. Maryman’s white cell and platelet count, her sedimentation rate and level of C-reactive protein, which indicate inflammation, were markedly elevated. Maryman clearly seemed to have an infection. During a scan of her abdomen in May 2013, doctors discovered a five-centimeter mass — roughly the size of a thumb — on her left ovary; the radiologist suspected it was a benign and very common fibroid tumour. But by Thanksgiving, her fever came roaring back and blood tests ordered by the oncologist, who had continued to monitor her regularly, showed that her inflammatory markers were again very elevated. Can you tell the cause?
Option 1: Lyme disease
Option 2: HIV
Option 3: Giant cell arteritis
Option 4: Takayasu’s arteritis
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