Fig 2: Line chart showing blood glucose fluctuations and regular insulin administration.
On her 2nd DOA, Carotid CT angiogram revealed features likely of type 1 Takayasu arteritis with following findings (Figure 3). There was circumferential symmetric thickening of arch of aorta and its all branches with left common carotid artery stenosis by 90% in its entire course. Patient BP was monitored and planned to add amlodipine 2.5 mg per oral OD diagnosing reflex hypertension. CTVS recommended steroid treatment for the initial two weeks followed by bypass channel formation between right common carotid artery and right brachiocephalic trunk or arch of aorta.
She was planned to give induction with high-dose methylprednisolone (1g) for three doses in three days followed by tablet prednisolone (60 mg per oral OD) and Azathioprine (50 mg per oral OD) with a plan to increase azathioprine to 50mg twice a day (BD) and taper dose of prednisolone in next two weeks after baseline complete blood counts monitor. She was also prescribed tablet folic acid (5 mg, five times a week), tablet aspirin (75 mg), tablet rosuvastatin and tablet cefuroxime and clavulanic acid (500 mg). Regular insulin was administered as per requirement dictated by blood glucose level. The use of antibiotics was justified for focus of infection seen in routine urine examination.