A 22 year old female Asian immigrant presents with complaints of malaise, fever, arm pain, loss of appetite, and visual problems. Her mother states that she fainted 1 week ago. The physician cannot palpate the patient's lower extremity pulses and notes that the dial pulses are weak. The erythrocyte sedimentation rate (ESR) is elevated. Which of the following is the most likely diagnosis?
Takayasu's aeritis is an uncommon disorder that is most prevalent in young Asian women. In Takayasu's, an inflammatory process produces fibrous thickening of the aoic arch, causing narrowing or near obliteration of the origins of aeries that branch from the arch. Absent or diminished pulses are noted, especially in the upper extremities. Involvement of the carotid circulation can produce ocular disturbances or other neurological dysfunction (syncope or, less commonly, stroke). Buerger's disease (thromboangiitis obliterans is a disease of young-to middle-aged adult (predominantly males) smokers. It is characterized by segmental thrombosis of aeries and veins, often in extremities. Kawasaki's disease is usually seen in children, and is characterized by rash, fever, conjunctivitis, and lymphadenopathy. Coronary vasculitis and aneurysms may occur. Thrombophlebitis usually involves the deep veins of the legs and often occurs in association with predisposing factors such as immobilization, clotting disorders, hea disease, cancer, pregnancy, or tissue injury. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 9. Vascular Pathology. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.
Buerger's disease
Kawasaki's disease
Takayasu's aeritis
Thrombophlebitis