Prolonged follow-up of a case of Takayasu’s arteritis presenting with spastic paraplegia secondary to thoracic compressive myelopathy

This is the case of a 63-year-old woman who presented with a few weeks' history of progressive bilateral lower limb weakness and spastic paraparesis. Urgent imaging revealed spinal cord compression caused by dural thickening between the T2 and T9 levels, as well as an incidental finding of ongoing aortitis. The impression of a large-vessel vasculitis with concurrent thoracic pachymeningitis was given. The patient underwent an urgent thoracic laminectomy and tissue samples were sent for culture and histology. Tissue cultures later identified Enterobacter and Pseudomonas species, introducing further diagnostic complexity. Histology showed findings consistent with a non-specific chronic inflammatory process. An autoimmune and vasculitic screen revealed nothing of note and IgG4 levels were within normal range. A diagnosis of Takayasu's arteritis with thoracic compressive myelopathy was made. Long-term follow-up was essential to the patient's management following her diagnosis of Takayasu's arteritis. Ongoing surveillance was required to assess physical recovery after prolonged immunosuppression and rehabilitation, as well as to recognise and detect delayed complications. These were related both to the vasculitis and to her prolonged corticosteroid therapy, despite an initial favourable response to the multidisciplinary treatment. LEARNING POINTS: Spastic paraplegia is an uncommon and potentially misleading presentation of Takayasu's arteritis. The resulting dural thickening may initially mimic primary spinal pathology.The presence of concurrent large-vessel inflammation is a crucial diagnostic clue; positron emission tomography/computed tomography scans and magnetic resonance imaging are invaluable in confirming vasculitis and monitoring treatment response.Long-term follow-up is essential, as it reveals new and significant complications related both to Takayasu's arteritis and to its management.