Takayasu arteritis presenting with severe biventricular dysfunction and renal artery stenosis in a pediatric patient: a case report.

Introduction and importance: Takayasu arteritis (TA), a rare chronic granulomatous vasculitis, predominantly affects large- and medium-sized arteries, such as the aorta and its branches. It can lead to life-threatening complications, particularly in pediatric cases where delayed diagnosis and multi-organ involvement are common. Systemic hypertension and vascular abnormalities, including renal artery stenosis, are significant manifestations that pose diagnostic and therapeutic challenges. Case presentation: We report the case of a 14-year-old girl from Nepal who presented with severe biventricular dysfunction, refractory systemic hypertension, and generalized anasarca. Initial investigations revealed bilateral renal artery stenosis and circumferential wall thickening of the abdominal aorta, confirming a diagnosis of TA. Despite aggressive medical management with immunosuppressive therapy and antihypertensives, her condition remained critical, necessitating urgent percutaneous transluminal renal artery angioplasty. The angioplasty successfully restored renal artery perfusion, resulting in significant clinical improvement and normalization of blood pressure. Her cardiac function stabilized, and she was discharged on a reduced antihypertensive regimen. Follow-up imaging demonstrated sustained renal artery patency. Clinical discussion: This case underscores the importance of early diagnosis, multidisciplinary management, and timely interventional procedures in pediatric TA. Renal artery stenosis in TA can exacerbate hypertension and cardiac dysfunction, as seen in this patient. The success of angioplasty highlights the potential of interventional radiology as a life-saving modality in severe cases. Conclusion: Pediatric TA with multi-organ involvement requires a coordinated, multidisciplinary approach for optimal outcomes. This case exemplifies the complexities of managing refractory hypertension and advanced vascular complications in TA and emphasizes the critical role of advanced interventional techniques.