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Vasculitis or fibromuscular dysplasia?

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Clinical record

A 45-year-old previously well woman of Filipina descent was admitted to hospital following an episode of vertigo that spontaneously resolved after 2 minutes. The patient denied experiencing any associated symptoms. Her past history included hypertension, diagnosed when she was 27 years old. She did not smoke or drink alcohol. Her brother suffered a stroke at age 46 years.

On physical examination, the patient’s blood pressure was 160/100 mmHg in the right arm and 140/95 mmHg in the left arm. Her blood glucose level was 6.8 mmol/L (reference interval [RI], 4–11 mmol/L). There were loud bruits in both carotid arteries and the left renal artery. The right radial pulse was stronger than the left. Both lower limb pulses were palpable. Results of the remainder of the physical examination were normal.

Results of a full blood count, tests for urea and electrolyte levels, liver function tests, thyroid function tests, and tests for troponin and C-reactive protein levels were normal. Erythrocyte sedimentation rate was slightly elevated at 22 mm/h (RI, < 20 mm/h). Results of vasculitis screening — tests for antinuclear antibodies, extractable nuclear antigens, antibodies to double-stranded DNA and antineutrophil cytoplasmic antibodies — were normal. Results of thrombophilia screening — tests for anticardiolipin IgG, antithrombin III, protein…