Table 1 Patient’s course of the disease

When diagnosed

Generalized myalgia and arthralgia, severe pain in the left shoulder and elbow with numbness and tingling in the left arm, dyspnea, pallor, constitutional symptoms, intermittent epigastric abdominal pain occasionally associated with vomiting and diarrhea, headache, and epistaxis

Lymphadenopathy, pulselessness with unobtainable BP in the left arm. BP was 130/70 and 140/90 mmHg in the right arm and lower limbs, respectively. Bruits over the left supra- and subclavian areas

10

70

13,200

(77/12)

113

731 × 10³

35.5

Figs. 1, 2

Prednisolone 1 mg/kg/day

Methotrexate 10 mg/m²/weak

Aspirin 1–2 mg/kg/day

First relapse (after 4 months)

Chest pain radiating to the left arm, syncope, dyspnea, fever, and fatigue

Bruits over the left and right supra- and subclavian areas. Pulselessness with unobtainable BP in both arms.

BP in the lower limbs was elevated (150/80 mmHg)

11.5

73

14,800

(74/19)

99

660 × 10³

12.7

Fig. 3

As above

Cyclophosphamide 1000 mg/m²/month

Amlodipine 5 mg/day for hypertension

Second relapse (after 8 months)

Occipital headache, abdominal pain, vomiting, arthralgia, and fatigue

Cushing appearance, bruits over the right supra- and subclavian areas, pulselessness with unobtainable BP in both arms.

BP in the lower limbs was 138/84 mmHg

10.4

83

15,800

(88/16)

122

466 × 10³

15.6

Fig. 4A, B

Prednisolone and cyclophosphamide were continued as described above.

Methotrexate was replaced with azathioprine 100 mg/day.

Amlodipine 5 mg/day

Aspirin 1–2 mg/kg/day

Last follow-up

(after 14 months)

Only mild arthralgia at the knees, all other symptoms were relieved

Pulse was present in four extremities.

BP was measurable in four extremities and was approximately 120/70 mmHg

13.4

84

8300

(77/15)

5

384 × 10³

20

Fig. 5A, B

Prednisolone (1 mg/kg)

Azathioprine 2 mg/kg/day

Amlodipine 5 mg/day

Aspirin 1–2 mg/kg/day