We report the case of a 16 year old girl with Takayasu’s arteritis, which started with a bilateral neck pain associated with fever and a carotid murmur. A Doppler ultrasound of the neck showed a bilateral carotid involvement with thickened arterial walls and increased blood flow velocity, and a computed tomographic scan of the aorta showed involvement of the abdominal tract.

Treatment was started with oral prednisone and methotrexate, with a very poor clinical response (fig 1); acute phase reactants were significantly raised, recurrent fever persisted, and abdominal pain developed showing that the abdominal aorta was affected. Treatment with intravenous boluses of high dose methylprednisolone gave transient benefit; treatment with glucocorticoids (GCs) was continued and additional immunosuppressant drugs were progressively added, still without any clinical and laboratory sign of remission. To confirm that the patient was taking her treatment, oral betamethasone was given under strict supervision during a period of admission in hospital, but still with no sign of …