Response to intravenous gammaglobulin in refractory Takayasu arteritis

Abstract

Takayasu arteritis (TA) is a large-vessel vasculitis which affects the aorta and its major branches. Steroids are the cornerstone of treatment; however, more than half of the patients relapse, requiring additional immunosuppressive agents. Open studies have suggested that methotrexate, cyclophosphamide, azathioprine, mycophenolate mofetil and anti-TNF therapy may be useful in such cases. We conducted a case report of a patient with TA with multiple relapses despite methotrexate, steroids, rituximab, cyclophosphamide, infliximab, percutaneous, and surgical revascularization. Intravenous immunoglobulin (IVIg) was employed, obtaining total and sustained control of vasculitic manifestations, achieving tapering and suspension of steroids as well as diminution of acute phase reactants