Takayasu's arteritis presenting in a pregnant woman with ankylosing spondylitis: Case report and review of the literature

Introduction: Coincidence of ankylosing spondylitis (AS) and Takayasu arteritis (TA) in single person especially women is rare. Case report: We report a 31 year old Iranian woman with AS from 5 years and giving history of inflammatory low back pain, morning stiffness, bilateral sacroiliac tenderness, positive Schober test and enthesitis, negative human leucocytic antigen (HLA-B27) and sacroiliitis on plain X-ray. The patient was under treatment. After 2 years she returned with increased back, hip and entheseal pain as well as claudications in left hand during the eighth week of gestation in her first pregnancy. She discontinued the non-steroidal anti-inflammatory drugs three months before pregnancy and on examination was pulseless on the left side. Color Doppler studies showed segmental stenosis and increased intima thickness in subclavian, axillary and proximal brachial arteries of the left hand with reduced blood flow in those arteries. The right hand was normal. Laboratory result showed microcytic anemia (hemoglobin = 10.8 g/dl, mean corpuscular volume = 66 fL) and erythrocyte sedimentation rate = 104/1st hour. The findings were indicative of TA and she was treated with prednisolone and azathioprine and had successful delivery to full term normal boy at 39th week gestation by Caeserian section. She was followed for two more months after delivery with no complications. Conclusion: Both TA and AS have no significant adverse effects on pregnancy if diagnosed and timely treated properly. When they occur concomitantly, more attention and care is needed to prevent complications. (C) 2020 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).