Case Study: Takayasu’s Arteritis
At a Glance:
- 22-year old female was airlifted to UVA with pulmonary hemorrhage and renal failure
- After multiple tests, she was diagnosed with Takayasu’s Arteritis, a rare systemic inflammatory disease
- Treatment included high-dose steroids and plasma exchange, in addition to two procedures to restore blood flow to vital organs
- After 20 years, patient is successfully managing her condition with the help of multiple UVA specialists
On Christmas Day 1999, 22-year-old Angela Hurt was airlifted to UVA Medical Center from a community hospital in Clifton Forge, Va. UVA nephrologist Mark Okusa, MD, was on call that day.
Hurt was experiencing pulmonary hemorrhage and renal failure. “Based on the information from the referring hospital, we began treating her for Goodpasture Syndrome with plasma exchange and steroids,” he says. “Yet further testing, including a magnetic resonance angiogram, demonstrated the typical vascular finding of Takayasu’s arteritis.”
Takayasu’s arteritis is a rare systemic inflammatory disease that affects the large vessels in the body. It is most common in women of Asian descent; Hurt is Caucasian. “This was not a straightforward diagnosis,” says Okusa. “Although we see other forms of vasculitis, this was our first case like this in recent times and we haven’t had a case as dramatic since.”
Because Takayasu’s causes stenosis of the large arteries, the primary treatment goal is to maintain blood flow to vital organs. During her initial hospitalization, Hurt required transluminal angioplasty on the completely occluded left renal artery to normalize blood flow and kidney function (the right kidney was unsalvageable).
“We have one of the few specialists in the region who can perform this procedure. If she had gone anywhere else, she would be on dialysis for the rest of her life,” says Okusa. Less than a year later, Hurt underwent successful aortobifemoral bypass grafting to improve circulation to her legs.
Beyond Good Medicine
To effectively manage a chronic and complex illness like this requires more than just good medicine. It requires a partnership between a patient and a team of providers. “Both parties are critical for good care,” says Okusa.
For him, no one exemplifies this better than Hurt. “There are things we deal with as physicians in the acute phase, but [Angela’s] positive outcome is a testament to her healthy lifestyle,” he says. “She is compliant with her medications, she exercises, she keeps her weight under control — she is in charge of her life. If it wasn’t for her resolve, she wouldn’t be here today.”
Now 40 years old, Hurt has adapted to the demands and limitations of her illness. She and her husband David travel to UVA every 2-3 months, where Angela sees a multidisciplinary team of specialists, including Okusa, her nephrologist, as well as a cardiologist, hematologist, rheumatologist and others all working together to effectively manage her condition. “They are very accommodating so I’m able to schedule multiple appointments for each visit,” says Hurt.
By putting her faith in her care team and her family, Angela is able to stay positive. “We live each day like it’s our last. I do get tired, but I push through,” she says. “I dig deep because the reward is worth it. As long as we stay positive and put our faith in the doctors, we’ll be ok.”
“This is what UVA is all about — providing differentiating, state-of-the art care to improve the health of our patients,” says Okusa. “We have the experience here to treat the most complex patients.”