Acute Psychosis and Takayasu Vasculitis

Takayasu arteritis is one of the large vessel vasculitis with variable clinical features in Indian patients. It is common in males and may be associated with tuberculosis and often presents with large vessel wall inflammation, obstruction and aneurysm. A 23-year-old female presented with features of acute psychosis and during evaluation and following electroconvulsive therapy she was found to be tachycardic and pulse less in one arm. Further CT angiogram proved features of aortoarteritis with raised inflammatory markers and her infective screen including TB came back as negative. She was treated with steroids, losartan and corticosteroids and Methotrexate was added as steroid sparing immune suppression. She remains disease free and doing well. Literature review suggests increasing incidence of this vasculitis and early effective treatment helps to reduce morbidity and prolong disease free remission.