Epigastric Abdominal Pain and Weight Loss in a 17-year-old Male

Introduction: Takayasu arteritis is an idiopathic, chronic, large vessel arteritis involving the aorta and its primary branches. Although the disease has a worldwide distribution, it has a high prevalence in Japan (40 per million) and a low prevalence in the United States (0.9 per million). Our patient, an African-American teenage male with TA, is exceedingly rare. Case Report: A 17-year-old African-American male with no significant past medical history presented to the Emergency Department with one month of epigastric abdominal pain and a 20-pound weight loss. The pain was dull, without radiation, and initially intermittent, but recently became constant. The pain did not improve with food, naproxen, or stooling. Abdominal exam elicited moderate epigastric tenderness without rebound. No hepatosplenomegaly or costovertebral angle tenderness was noted. Upper and lower extremity peripheral pulses were symmetric and 2+. A complete blood count showed leukocytosis (15.9 thousand/mm3), microcytic anemia (7.8 g/dl), and thrombocytosis (1109 thousand/mm3). C-reactive protein (14 mg/dl) and erythrocyte sedimentation rate of (117 mm/h) were both markedly elevated. Fecal calprotectin was also elevated (494 mcg/g). An abdominal and pelvis computed tomography (CT) scan revealed inflammation and luminal irregularity of the visualized aorta and origins of the major branch vessels, consistent with vasculitis. A CT angiogram (CTA) of the chest confirmed luminal irregularity and intimal thickening involving the thoracic aorta and supra-aortic vessels (Figure 1). A CTA of the head and neck showed a near complete occlusion of the mid and distal right common carotid artery (Figure 2). Based on the clinical presentation and the imaging findings, he was diagnosed with pre-pulseless Takayasu arteritis (TA). Discussion: Vessel inflammation leads to wall thickening, fibrosis, stenosis, and, in some, complete occlusion of the artery, which leads to the classic