{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T06:27:42Z","timestamp":1765261662547,"version":"3.46.0"},"reference-count":42,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Takayasu arteritis, a rare chronic large\u2010vessel vasculitis primarily affecting the aorta and its major branches, poses significant diagnostic and therapeutic challenges due to its heterogeneous manifestations and potential for severe vascular complications. This case report details a 40\u2010year\u2010old female presenting with a 12\u2010month history of right arm pain and restricted movement, ultimately diagnosed with Takayasu arteritis. The patient exhibited hallmark features, including a diminished right radial pulse, blood pressure asymmetry (150\/92\u2009\n                    <jats:styled-content style=\"fixed-case\">mmHg<\/jats:styled-content>\n                    left, 125\/80\u2009\n                    <jats:styled-content style=\"fixed-case\">mmHg<\/jats:styled-content>\n                    right), and mild right arm weakness (4\/5 strength). Physical examination of the shoulders revealed limited active range of motion in the right shoulder, with abduction restricted to 90\u00b0 and external rotation to 30\u00b0, likely due to ischemic changes, while the left shoulder showed full range of motion. Laboratory findings confirmed active inflammation, with C\u2010reactive protein (\n                    <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content>\n                    ) at 18.4\u2009mg\/L and erythrocyte sedimentation rate (\n                    <jats:styled-content style=\"fixed-case\">ESR<\/jats:styled-content>\n                    ) at 45\u2009mm\/h, alongside mild anemia (11.5\u2009g\/\n                    <jats:styled-content style=\"fixed-case\">dL<\/jats:styled-content>\n                    ) and reactive thrombocytosis (360\u2013410\u2009\u00d7\u200910\n                    <jats:sup>3<\/jats:sup>\n                    \/\n                    <jats:styled-content style=\"fixed-case\">\u03bcL<\/jats:styled-content>\n                    ).\n                    <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>\n                    angiography revealed thrombotic occlusion of the left vertebral artery (60%\u201370%), significant narrowing with thin flow in the left common carotid and subclavian arteries, moderate occlusion with reconstituted flow in the left mid and distal brachial and radial arteries, and narrowing in the right ulnar and interosseous arteries. Additionally, a 4.0\u2009cm infrarenal aortic aneurysm was identified, a potentially life\u2010threatening complication. Treatment was initiated with intravenous methylprednisolone (1\u2009g daily for 3\u2009days), transitioning to oral prednisone (50\u2009mg\/day), combined with ibuprofen for pain (400\u2009mg as needed, up to 1200\u2009mg daily), amlodipine and nifedipine for hypertension, and esomeprazole for gastric protection. A multidisciplinary approach was emphasized, integrating rheumatology and vascular surgery, with plans for steroid\u2010sparing agents (methotrexate or azathioprine) and serial aneurysm surveillance. This case underscores the complexity of Takayasu arteritis, highlighting the need for comprehensive vascular assessments, tailored immunosuppression, and vigilant monitoring to prevent complications and optimize outcomes.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.71362","type":"journal-article","created":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T02:22:06Z","timestamp":1761963726000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the Pulselessness: A Multifaceted Case of Takayasu Arteritis With Aneurysmal Complications and Extensive Upper Limb Vascular Occlusion in a 40\u2010Year\u2010Old Female"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7338-4329","authenticated-orcid":false,"given":"Sakib","family":"Abrar","sequence":"first","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8995-1058","authenticated-orcid":false,"given":"Ibrahim","family":"Khalil","sequence":"additional","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8582-5814","authenticated-orcid":false,"given":"Shah Tanvir","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabiha Rahman","family":"Spriha","sequence":"additional","affiliation":[{"name":"Dhaka Medical College and Hospital  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3949-9388","authenticated-orcid":false,"given":"Md. Imran","family":"Hossain","sequence":"additional","affiliation":[{"name":"Manikganj Medical College and Hospital  Manikganj Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md Abu","family":"Sayed","sequence":"additional","affiliation":[{"name":"Chattogram Medical College and Hospital  Chattogram Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.80.3.429"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-198503000-00002"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep153"},{"issue":"6","key":"e_1_2_11_5_1","first-page":"497","article-title":"Takayasu's Arteritis: A Changing Disease","volume":"14","author":"Vanoli M.","year":"2001","journal-title":"Journal of Nephrology"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2011.08.001"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0167\u20105273(96)02813\u20106"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002281\u2010200401000\u201000007"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780330810"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2007.07.014"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.184.6.01841945"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010103\u20101\u2010121"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.014321"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20108703(92)90967\u2010z"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0002\u20108703(77)80178\u20106"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.57.1.27"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2004.04.026"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.196.1.7784596"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/000331979104200408"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.175.6.1751727"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0009\u20109260(05)81930\u20100"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.141347"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010155\u20107\u2010201110040\u201000005"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/03009740510026526"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1067\/mva.1990.23183"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.55.7.481"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-857X(21)00371-9"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109343(94)90131\u20107"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0167\u20105273(98)00171\u20105"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis\u20102017\u2010211878"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2005.10.010"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.058032"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.027094"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22404"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010120\u201011\u2010199406010\u201000004"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2010.82"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(00)02701\u2010X"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kel323"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.190045"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0245612"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2012.01.013"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.814075"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0167\u20105273(96)88780\u20108"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71362","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T05:52:39Z","timestamp":1765259559000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.71362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":42,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/ccr3.71362"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.71362","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"type":"print","value":"2050-0904"},{"type":"electronic","value":"2050-0904"}],"subject":[],"published":{"date-parts":[[2025,10,31]]},"assertion":[{"value":"2025-08-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71362"}}