Ishaq and Shabbir Journal of Medical Case Reports 2011, 5:466 http://www.jmedicalcasereports.com/content/5/1/466 serum iron, total iron binding capacity and transferrin, antinuclear antibodies, electrocardiogram, echocardio- graph and electroencephalogram (EEG). A computed tomography angiogram (CT-A) of her chest showed a normal ascending aorta, descending aorta and arch of the aorta but there was diffuse intimal thickening of major branches of the aorta including the brachiocephalic, right common carotid, and left subcla- vian arteries (Figure 1). There was extensive collateral circulation in the subcutaneous tissue in her anterior and posterior neck, chest and axillae. Our patient had been taking antiepileptic medication for over a month. This was immediately halted because her liver enzymes were elevated above normal range; this decision was also supported by the negative results of the EEG report (the alpha wave was present on clo- sure of eye and had a frequency of 10 cycles per second; which disappeared when the patient was instructed to open her eyes, beta, theta and delta waves had frequen- cies of 14, 5 and 3 cycles per second). Our patient was kept on one milligram per kilogram bodyweight per day of corticosteroid and was kept under a weekly follow-up for two months to monitor her response to the treat- ment. Our patient is responding well. Figure 1 CT-A of arch of the aorta and its major branches showing diffuse intimal thickening, with narrowing of the origins of major branches of the arch of the aorta involving brachiocephalic, right common carotid and left subclavian arteries. Page 2 of 3 Discussion Based on the clinical history, examination, imaging stu- dies and serum electrophoresis our patient was diag- nosed with Type I TA with beta thalassemia trait. TA may present with nonspecific symptoms such as fever, arthralgia and weight loss. It may also present with sys- temic complaints depending on the site of involvement; for example neurological symptoms like dizziness (33%) and impairment of vision (20-30%), carotid bruit (70%), deficit of upper limbs pulses (53%) and the deficit of other pulses, all of which were seen on examination of our patient [4]. Patients with TA may also present with epilepsy [5]. Fifty percent of patients with TA have a normal ESR [6]. Patients with beta thalassemia trait also have a raised ESR. Anemia in TA can be normocytic and normochromic, but our patient presented with microcytic hypochromic anemia which is commonly due to an iron deficiency in females of reproductive age in this part of the world [7]. To further confirm our diag- nosis of beta thalassemia, a serum electrophoresis was done to firmly establish that the anemia was due to beta thalassemia trait and to exclude iron deficiency anemia. The differential diagnosis of TA may include congeni- tal tissue matrix disorders (Marfan and Ehler-Danlos syndromes), infectious large vessel aneurysm (mycobac- terial, syphilitic, or fungal) and autoimmune diseases (systemic lupus, Cogan syndrome and Behçet’s disease); however these disorders were ruled out because they are not associated with large vessel stenosis as seen in TA. Large vessel vasculitis was ruled out because it is asso- ciated with the advanced age (Kawasaki disease and giant-cell arteritis). Sarcoidosis is also considered as a differential of TA, but is only diagnosed after all the dif- ferentials have been ruled out. Current studies postulate that non-invasive imaging techniques are very helpful in the early diagnosis of TA, such as magnetic resonance imaging, ultrasound and 18F-fluorodeoxyglucose positron emission tomography. In comparison to standard angiography, they also pro- vide a tool for a comprehensive monitoring of the dis- ease [8]. Treatment of TA is a real challenge for the clinicians and in spite of current treatment vascular lesions develop frequently. Remission occurs in patients using immunosuppressive drugs (for example metho- trexate) along with corticosteroids, but unfortunately reactivation is common when the dose of corticosteroids is brought down. The use of surgical and endovascular procedures are safe and associated with low mortality and morbidity. Good results have been achieved using bypass grafts, whereas percutaneous transluminal angio- plasty gives better results for smaller lesions. Conven- tional stents used in vessel patency are just not good enough in the long-term [9]. The use of tumor necrosis