Aim:
To present case of Takayasu’s arteritis in pregnancy, coexisting with chronic hepatitis B and possible latent tuberculosis (LTB), and to highlight management strategies for this complex scenario.
Method:
Case report was used to prompt scoping literature review using the terms “Takayasu arteritis”, “pregnancy”, "chronic hepatitis B", "latent tuberculosis". The patient’s presentation, investigations, and management were reviewed.
Results:
A 37-year-old G3P1 North Indian woman presented in December 2024 with anaphylaxis during routine iron infusion. Computed tomography pulmonary angiography(CTPA), as part of investigation for SOB, incidentally revealed large vessel vasculitis involving thoracic aorta, brachiocephalic trunk, carotid and subclavian arteries. Clinical history included 3 months of raised inflammatory markers, anaemia, fatigue, and right shoulder pain. Examination revealed absent upper limb pulses and carotid bruits. Investigations showed elevated CRP of 41mg/L(<3mg/L), microcytic anaemia, chronic hepatitis B with viral load 14,200IU/mL(10-20IU/mL), and indeterminate QuantiFERON Gold.
The diagnosis of Takayasu arteritis was made, and due to high burden disease and risk of miscarriage, preeclampsia and growth restriction in pregnancy, induction of remission therapy was commenced at 8 weeks pregnancy. Treatment included prednisolone, infliximab, azathioprine, rifampicin, tenofovir, aspirin and metoprolol.
The pregnancy is managed with multidisciplinary surveillance with regular blood tests for pre-eclampsia and a standardised blood pressure measurement on left calf. She’s planned to have a caesarean section (CS) with neuraxial anaesthesia.
Conclusion:
This case illustrates the importance of a coordinated multidisciplinary approach in managing newly diagnosed Takayasu arteritis with coexisting chronic infections during pregnancy to optimize maternal and fetal outcomes.