1
|
Fuentes Domínguez L, Cervera Bravo Á, Paniagua Correa C. Takayasu's arteritis in an adolescent with fever of unknown origin: the contribution of PET-CT in the diagnosis. BMJ Case Rep 2022; 15:e248472. [PMID: 35414578 PMCID: PMC9006798 DOI: 10.1136/bcr-2021-248472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Finding the cause of fever of unknown origin can sometimes be a real challenge. We present an adolescent whose diagnosis was achieved after 4 months of fever onset by performing a positron emission tomography (PET)-CT. A young woman presented with prolonged, intermittent fever along with inflammatory and iron deficiency anaemia, loss of weight and abdominal and chest pain. First investigational studies showed high-titre positive antinuclear antibodies, extractable nuclear antibodies and anti-Sjögren's-syndrome-related antigen a autoantibodies (anti-SSA), and mild pericardial effusion and aortic regurgitation, but without meeting criteria for systemic lupus erythematosus. She had maxillary sinusitis that did not resolve with antibiotics. Further study displayed elevated calprotectin in faeces. After normal abdominal ultrasound and CT, an intestinal MRI showed thickening of the terminal ileum, orienting towards an inflammatory bowel disease. A colonoscopy showed only minor macroscopic changes. A PET-CT scan was finally requested, which exhibited a diffuse increase in metabolism in the wall of the thoracic and abdominal aortas, suggesting Takayasu's arteritis.
Collapse
|
2
|
Meryem E, Hatim E, Sergio EC, Khadija BEH, Ittimade N, Nabil MB. Chronic dissection of the abdominal aorta as a rare complication of Takayasu disease. Radiol Case Rep 2020; 15:2188-2191. [PMID: 32944115 PMCID: PMC7481880 DOI: 10.1016/j.radcr.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/03/2022] Open
Abstract
Takayasu's arteritis exposes to complications of varying severity, such as arterial stenosis, thrombosis, and more rarely aneurysms. Aortic dissection is a rare complication of Takayasu's disease, reported in few times in the literature, only 7 of which concern the abdominal aorta. We report the case of a 41-year-old woman followed for Takayasu disease for 15 years, who presented an asymptomatic and chronic dissection of the abdominal subrenal aorta. The patient underwent conservative medical treatment. After a follow-up of 17 months, the aortic dissection was still asymptomatic, with a stable appearance on follow-up imaging. To our knowledge, this is the first case report of asymptomatic aortic dissection as a rare complication of Takayasu disease.
Collapse
Affiliation(s)
| | - Essaber Hatim
- Central Radiology Department, CHU Ibn Sina, Rabat, Morocco
| | | | | | | | | |
Collapse
|
3
|
Pyo JY, Song JJ, Park YB, Lee SW. Pregnancy Morbidities in Korean Patients with Takayasu Arteritis: A Monocentric Pilot Study. Yonsei Med J 2020; 61:970-975. [PMID: 33107241 PMCID: PMC7593103 DOI: 10.3349/ymj.2020.61.11.970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/02/2022] Open
Abstract
We investigated pregnancy morbidities in Korean patients with Takayasu arteritis (TA) in a single tertiary hospital as a pilot study. We retrospectively reviewed the medical records of 12 pregnancies in seven patients with TA. All patients were diagnosed with TA based on the 1990 American College of Rheumatology classification criteria. The medical records of patients were well-documented, allowing review of clinical data including pregnancy morbidities. The angiographic and Ishikawa classifications at diagnosis and TA activity at delivery were assessed. Of the 12 pregnancies, two pregnancies ended in spontaneous abortion (16.7%), and one pregnancy (8.3%) had therapeutic abortion at 9 weeks due to maternal morbidity. Among the remaining nine pregnancies, only one child was delivered via normal spontaneous vaginal delivery, and the remaining eight were delivered by Caesarean section. Two out of nine (22.2%) neonates were born with low birth weight, and one of them was born at 30 weeks of gestation. The most common maternal complication was hypertension affecting 7/12 (58.3%) pregnancies. Preeclampsia occurred in one pregnancy, and gestational diabetes mellitus (GDM) occurred in two pregnancies. At delivery, disease activity of TA was stable in all pregnancies, and glucocorticoids were administered in nine pregnancies. Live birth rate of pregnant Korean patients with TA was 75%. Future studies are needed to reduce pregnancy-related complications.
Collapse
Affiliation(s)
- Jung Yoon Pyo
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jason Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
4
|
Sory BI, Yaya BEH, Abdoulaye C, Aly S, Diarra K, Kokoulo K, Morlaye S, Djibril S, Bassirou BM, Mariame B, Dadhi BM, Mamady C. [Dissection of the abdominal aorta revealing Takayasu´s disease: about a case in Guinea]. Pan Afr Med J 2020; 37:34. [PMID: 33209161 PMCID: PMC7648487 DOI: 10.11604/pamj.2020.37.34.21441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022] Open
Abstract
Takayasu´s disease (TD) is a chronic inflammatory arteriopathy affecting the aorta, its main branches and the pulmonary arteries. It was first described in 1908 by the Japanese ophthalmologist Mikito Takayasu. The study involved a 78-year-old patient with no known history of cardiovascular disease, admitted with abdominal pain, pain in the right lower limb when walking, insomnia. These symptoms had progressed over 1 year. Physical examination showed normal heart rate of 87 beats per minute without pathological noises, with absence of right pedal pulse, blood pressure 120/78 mmhg, free lungs, flexible abdomen, and a beating mass in the right iliac fossa whose auscultation showed continuous murmur. The remainder of the physical examination was normal. Abdominal CT angiography confirmed extensive aortic dissection at the abdominal aorta with synchronous opacification of both channels, thrombotic aneurysm of the primitive iliac arteries measuring 48mmx100mm on the right and 38mm x 90mm on the left, with no visible fissurization. We report a case abdominal aorta dissection associated with thrombus formation in the primary iliac arteries revealing Takayashu´s disease treated in the Department of Cardiology at the Ignace Deen National Hospital. The rate of abdominal aorta dissection in patients with Takayasu´s disease is rare. It is most often diagnosed in the occlusive phase. Prognosis depends on possible complications.
Collapse
Affiliation(s)
- Barry Ibrahima Sory
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Balde El Hadj Yaya
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Camara Abdoulaye
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Samoura Aly
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Koivogui Diarra
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Koivogui Kokoulo
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Soumaoro Morlaye
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Sylla Djibril
- Service des Urgences Médico-Chirurgicales de l'Hôpital National Donka, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Bah Mamadou Bassirou
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Beavogui Mariame
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Balde Mamadou Dadhi
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| | - Conde Mamady
- Service de Cardiologie de l´Hôpital National Ignace Deen, Centre Hospitalier Universitaire de Conakry, Conakry, République de Guinée
| |
Collapse
|
5
|
Wang Y, Jia SJ, Zhou Y, Li J, Zhao X, Zhao QM, Yang GL. A study on the risk factors of coronary artery disease in patients with Takayasu arteritis. J Thorac Dis 2020; 12:2031-2038. [PMID: 32642105 PMCID: PMC7330393 DOI: 10.21037/jtd-20-267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The aim of this study was to investigate the risk factors of Takayasu arteritis (TA) involving the coronary artery. Methods Patients with TA involving coronary artery were included in this study. According to the patients’ condition of coronary artery involvement, they were divided into two groups: group A: TA involved coronary artery disease [at least one coronary artery stenosis (≥50%)] and group B: TA did not involve coronary artery. A logistic regression model was used to analyze the risk factors of arteritis involving the patients’ coronary artery lesions. Results A total of 442 TA patients were included in this study. The patients were significantly older in group A than those patients in group B (52.54±11.17 vs. 37.73±12.72, P<0.001). The age of onset in group A was significantly older than those patients in group B (42.21±11.46 vs. 32.74±13.13, P<0.001). The patients in group A had a longer course of disease (P<0.001), larger BMI (P=0.002) and higher rates of smoking, drinking, diabetes, dyslipidemia (P<0.05) when compared with group B. The level of eGFR was significantly decreased and the UA and TG levels were significantly increased in group A when compared with group B(P<0.05). Besides, the risk factors for TA involving coronary artery included the age of TA onset (OR =1.143, 95% CI: 1.007–1.298, P=0.039), course of TA (OR =1.165, 95% CI: 1.025–1.324, P=0.020), and BMI (OR =1.100, 95% CI: 1.021–1.185, P=0.013). Conclusions The later the age of TA onset, the longer the course of TA onset and the more traditional risk factors associated with atherosclerosis, the more vulnerable patients are to coronary artery involvement and this may not be related to clinical disease activity.
Collapse
Affiliation(s)
- Yang Wang
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Shu-Jie Jia
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yun Zhou
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jing Li
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xin Zhao
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Quan-Ming Zhao
- Department of Special medical, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Guan-Lin Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| |
Collapse
|
6
|
Frikha F, Garbaa S, Bouattour Y, Snoussi M, Loukil H, Ben Salah R, Bahloul Z. [Tocilizumab for refractory Takayasu arteritis with aortic aneurysm]. JOURNAL DE MEDECINE VASCULAIRE 2019; 44:237-239. [PMID: 31029281 DOI: 10.1016/j.jdmv.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/27/2019] [Indexed: 06/09/2023]
Abstract
Takayasu arteritis (TA) is a form of large vessel vasculitis (LVV) which affects the aorta and the main arteries. Many reports showed efficacy of biologic drugs (TNF α inhibitors and interleukin 6 inhibitors) in refractory TA cases. We report the case of a 46-year-old woman with refractory TA complicated by giant aortic aneurysm (AA) and severe hypertension, treated efficacy with tocilizumab (anti-interleukin 6 receptor monoclonal antibody).
Collapse
Affiliation(s)
- F Frikha
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie.
| | - S Garbaa
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - Y Bouattour
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - M Snoussi
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - H Loukil
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - R Ben Salah
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - Z Bahloul
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| |
Collapse
|