Question

A 12 year old boy presented with weak pulses in upper limbs. His BP was 90/60mmHg. He also had retinal haemorrhages. Most likely diagnosis is

• A. PAN (Polyarteritis Nodosa)
• B. Microscopic polyangiitis
• C. Takayasu arteritis
• D. HSP (Henoch-Schonlein Purpura)

Hint:

Think about which large-vessel vasculitis causes absent pulses and is known as pulseless disease.

Answer 1

The Correct Option is C

Diagnosis: Takayasu arteritis

Vessel size classification of vasculitides:
- Large vessel: Takayasu arteritis, Giant cell arteritis
- Medium vessel: PAN, Kawasaki disease
- Small vessel: HSP, Microscopic polyangiitis, Granulomatosis with polyangiitis

Why Takayasu arteritis fits:
1. Age: young patient (common in females aged 10-40, but males possible)
2. Weak pulses in upper limbs -- granulomatous inflammation narrows subclavian/axillary arteries
3. Low BP (90/60 mmHg) -- reduced cardiac output due to aortic arch involvement
4. Retinal haemorrhages -- ocular ischaemia from carotid artery involvement

Takayasu arteritis = Pulseless disease / Occlusive thromboaortopathy

Investigation of choice: MR angiography or CT angiography showing wall thickening and luminal narrowing of aorta and branches.

\[\boxed{\text{Takayasu Arteritis}}\]