The patient was given a pulse dose of glucocorticoids with methylprednisolone 500 mg intravenous daily for three days with improvement in the strength of her left brachial and radial pulses over the course of treatment. She was also initiated on aspirin 81 mg daily and azathioprine 50 mg daily, which was further titrated as an outpatient. After the glucocorticoid pulse, the dose was reduced to prednisone 1 mg/kg/day. Aortic valve replacement was deferred in order to treat the inflammatory vascular process and because she was well compensated clinically. She returned a month later and continued to have stable heart failure symptoms, although she had episodes of left-side amaurosis fugax, lasting less than 15 seconds. Her glucocorticoid dose will be tapered in anticipation of an aortic valve replacement.
A 31-year-old Hispanic woman presented to the hospital with hypertension and renal failure.