Takayasu Arteritis Unrecognised for Twelve Years After Axillary Bypass in a G6PD-Deficient Woman — Cyclophosphamide Avoided, Steroids and Methotrexate Effective

Key finding

The vessel was fixed with surgery. The disease was never named. Two separable findings sit in this case. 1. A twelve-year diagnostic gap. The authors state plainly that the disease was missed because the arm symptoms were read as a structural arterial stenosis and treated with a graft. Revascularisation without immunosuppression does not address the inflammatory driver; the graft thrombosed, the stenosis progressed, and symptoms never resolved. Once the diagnosis was made, corticosteroids plus methotrexate produced significant improvement by four months — reduced claudication, restored pulses, falling inflammatory markers — and the vascular surgeon deferred angioplasty in favour of medical management. 2. A pharmacogenomic label narrowing therapy. Cyclophosphamide was deliberately avoided because of the risk of oxidative haemolysis in G6PD deficiency. The authors note G6PD defic

Framework connections: The Immune Priming

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