Refractory abdominal pain--atypical presentation of Takayasu's arteritis.
OBJECTIVE
We report an unusual presentation of chronic, intractable abdominal pain in a 42-year-old African American female that led to an extensive evaluation involving multiple abdominal surgeries over 20 years.


METHODS
There was no visible abnormality of celiac and mesenteric vasculature found by magnetic resonance angiography. Initial differential diagnosis included: Crohn's disease, cholecystitis, mesenteric ischemia referred pain from the surrounding ischemic structures, and other possible pathologies. Finally, Takayasu's arteritis was diagnosed based on the patient's clinical features and imaging studies in addition to the exclusion of other possible abdominal pathologies, and typical histologic findings of tissue biopsy. High-dose prednisone along with methotrexate resulted in a complete relief of her abdominal pain.


CONCLUSIONS
High index of suspicion and early diagnosis and treatment for such a condition will avoid invasive interventions and reduce the length of suffering and disability, as well as reduce the cost of health care.
Wu
Hong
H
Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. hongwu@mcw.edu
Virdi
Amarjit
A
D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D018810:Magnetic Resonance Angiography; D008727:Methotrexate / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D013625:Takayasu Arteritis / Q000150:complications* / Q000188:drug therapy
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011241:Prednisone; D008727:Methotrexate