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.