DOI: 10.12890/2026_006089
Prolonged follow-up of a case of Takayasu’s arteritis presenting with spastic paraplegia secondary to thoracic compressive myelopathy
Authors
victoria.farrugia.3@gov.mt
Keywords
Takayasu’s arteritis, spastic paraplegia, thoracic myelopathy, aortitis, immunosuppressionAbstract
This is the case of a 63-year-old woman who presented with a few weeks’ history of progressive bilateral lower limb weakness and spastic paraparesis. Urgent imaging revealed spinal cord compression caused by dural thickening between the T2 and T9 levels, as well as an incidental finding of ongoing aortitis. The impression of a large-vessel vasculitis with concurrent thoracic pachymeningitis was given. The patient underwent an urgent thoracic laminectomy and tissue samples were sent for culture and histology. Tissue cultures later identified Enterobacter and Pseudomonas species, introducing further diagnostic complexity. Histology showed findings consistent with a non-specific chronic inflammatory process. An autoimmune and vasculitic screen revealed nothing of note and IgG4 levels were within normal range. A diagnosis of Takayasu’s arteritis with thoracic compressive myelopathy was made. Long-term follow-up was essential to the patient’s management following her diagnosis of Takayasu’s arteritis. Ongoing surveillance was required to assess physical recovery after prolonged immunosuppression and rehabilitation, as well as to recognise and detect delayed complications. These were related both to the vasculitis and to her prolonged corticosteroid therapy, despite an initial favourable response to the multidisciplinary treatment.
References
- Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: a review. J Clin Pathol 2002;55:481–486. doi: 10.1136/jcp.55.7.481
- Somashekar A, Leung YT. Updates in the diagnosis and management of Takayasu’s arteritis. Postgrad Med 2023;135:14–21. doi: 10.1080/00325481.2022.2159723
- Chandrasekar N, Thandapani M, Govindasamy R, Rudrappa S, Vaithialingam B. Thoracic compressive myelopathy in a patient with Takayasu arteritis. Cureus 2023;15:e33496. doi: 10.7759/cureus.33496
- Murugan C, Kavishwar RA, Ramachandran K, Shetty AP, B T P, Rajasekaran S. Spinal Hypertrophic Pachymeningitis Causing Thoracic Myelopathy in a Patient of Takayasu Arteritis: A Case Report. JBJS Case Connect 2021;11. doi: 10.2106/JBJS.CC.21.00520
- Kim HA, Kim JH, Won JH, Suh CH. An unusual clinical manifestation of Takayasu’s arteritis: spinal cord compression. Joint Bone Spine 2009;76:209–212. doi: 10.1016/j.jbspin.2008.09.007
- Gautier F, Neumann L, Adle-Biassette H, Rubenstein E, Bernat AL, Chimon A, et al. Pachymeningitis associated with IgG4-related disease and ANCA positivity: case report and review of the literature. Autoimmun Rev 2023;22:103285. doi: 10.1016/j.autrev.2023.103285
- Slade SJ, Bauer EM, Stone VV, Dave AJ. Spinal IgG4-related hypertrophic pachymeningitis with spinal cord compression: case report and literature review. World Neurosurg 2019;130:65–70. doi: 10.1016/j.wneu.2019.06.130
- Grayson PC, Ponte C, Suppiah R, Robson JC, Gribbons KB, Judge A, et al. DCVAS Study Group. 2022 American College of Rheumatology/EULAR classification criteria for Takayasu arteritis. Ann Rheum Dis 2022;81:1654–1660. doi: 10.1136/ard-2022-223482
- Joseph G, Goel R, Thomson VS, Joseph E, Danda D. Takayasu arteritis: JACC Focus Seminar 3/4. J Am Coll Cardiol 2023;81:172–186. doi:10.1016/j.jacc.2022.09.051
- Hofbauer LC, Compston JE, Saag KG, Rauner M, Tsourdi E. Glucocorticoid-induced osteoporosis: novel concepts and clinical implications. Lancet Diabetes Endocrinol 2025;13:964–979. doi: 10.1016/S2213-8587(25)00251-7
