A 20 years old girl presented with low-grade fever, malaise, night sweats, weight loss, arthralgia and fatigue for 1 month. On examination peripheral pulses are weak in upper extrimities and bruit is present on carotid and subclavian artery. On investigating the child there was dilatation of proximal aorta. Most likely diagnosis is?
**Core Concept**
Takayasu arteritis is a large vessel vasculitis that primarily affects the aorta and its major branches, leading to stenosis, occlusion, or dilatation of these vessels. It is a systemic disease that can present with a wide range of symptoms including fever, weight loss, and joint pain.
**Why the Correct Answer is Right**
The patient's symptoms of low-grade fever, malaise, night sweats, weight loss, arthralgia, and fatigue are consistent with an inflammatory process. The presence of weak peripheral pulses in the upper extremities and a bruit on the carotid and subclavian artery suggest stenosis or obstruction of these vessels. The dilatation of the proximal aorta is a classic finding in Takayasu arteritis. The inflammation of the aorta and its branches leads to the formation of granulomas and subsequent damage to the arterial wall, resulting in stenosis or dilatation.
**Why Each Wrong Option is Incorrect**
**Option A:** Giant Cell Arteritis is a large vessel vasculitis that primarily affects the branches of the external carotid artery and is more common in older adults. While it can present with similar symptoms, the involvement of the proximal aorta and the patient's age make Takayasu arteritis more likely.
**Option B:** Kawasaki disease is a medium vessel vasculitis that primarily affects children and presents with fever, rash, lymphadenopathy, and conjunctivitis. The involvement of the aorta and the patient's symptoms do not match Kawasaki disease.
**Option C:** Buerger's disease is a small vessel vasculitis that primarily affects the limbs and is associated with smoking. The involvement of the aorta and the patient's symptoms do not match Buerger's disease.
**Option D:** Polyarteritis nodosa is a medium vessel vasculitis that can present with a wide range of symptoms including fever, weight loss, and joint pain. However, the involvement of the aorta and the patient's symptoms are more consistent with Takayasu arteritis.
**Clinical Pearl / High-Yield Fact**
Takayasu arteritis is a diagnosis of exclusion and requires a high index of suspicion, particularly in young women with symptoms of systemic inflammation and vascular involvement. A thorough physical examination and imaging studies, including Doppler ultrasound and CT angiography, are essential for diagnosis.
**Correct Answer:** C.