Isolated lower extremity vasculitis leading to progressive critical limb ischemia

Abstract

Giant cell arteritis is a large- and medium-vessel vasculitis that has been described as a systemic disease process with disseminated vessel involvement. Advances in vascular imaging techniques have demonstrated that involvement of the large vessels of the upper and lower limbs may be more prevalent than was once thought, although the clinical implications of this are unknown. Isolated lower extremity claudication without systemic or classic cranial symptoms, especially as a primary manifestation of giant cell arteritis, is rare. We present the case of a patient with isolated bilateral limb claudication that rapidly progressed to critical limb ischemia requiring urgent surgical intervention after steroid therapy. Our patient has consented to the publication of this report.

In response to: Unusual Case of Takayasu Arteritis of the Superficial Femoral Arteries without Involvement of the Upper Extremities

“…Thus, the ACR classification criteria cannot be solely used to diagnose TAK in the given case. Isolated bilateral superior femoral artery involvement has been observed in a reported case of giant cell arteritis (GCA), 4) however the age of presentation of the current patient is younger compared to the typical age of presentation of GCA. Isolated peripheral arterial involvement has also been reported in polyarteritis nodosa with isolated involvement of both the lower SFA without any visceral arterial involvement.…”

Localized Forms of Vasculitis

“…It is more commonly associated with other diagnoses, such as systemic vasculitis (e.g., Behçet's disease, AAV) or infections (e.g., tuberculosis, syphilis), which should always be sought [125]. Vasculitis restricted to the lower limbs, particularly the calves, has also been described [1,2] and patients with this variant of SOV may present AAV-, PAN-, or GCA-type lesions [126][127][128][129][130][131]. Rare cases of eosinophilic coronary monoarteritis [132][133][134] and isolated pulmonary arteritis, also named isolated pulmonary Takayasu's arteritis [135][136][137][138][139], have also been reported in the literature and may be associated with life-threatening disease manifestations.…”

Lower extremity arteries

“…Vasculitis A number of vasculitis conditions including substance abuse affect lower limb arteries (20). These conditions typically appear as arterial wall thickening in acute phase associated with thrombosis of vessels (Figure 9) which later on lead to stenotic lesions, dissections and aneurysm formation.…”