Takayasu's arteritis accompanied with massive pericardial effusion--a case report

Analysis of clinical features between active and inactive patients of Takayasu's arteritis with pulmonary arteries involvement

BACKGROUND

The aim of this study was to investigate the clinical characteristics of patients between active and inactive Takayasu's arteritis with pulmonary artery involvement (PTA) and to identify better markers of disease activity in these patients.

METHODS

Sixty-four PTA patients in Beijing Chao-yang hospital (2011 to 2021) were included. According to National Institutes of Health criteria, 29 patients were in active stage and 35 were in inactive stage. Their medical records were collected and analyzed.

RESULTS

Compared with inactive group, patients in active group were younger. More patients in active stage presented fever (41.38% vs 5.71%), chest pain (55.17% vs 20%), increased C-reactive protein (2.91 vs 0.46 mg/L), erythrocyte sedimentation rate (35.0 vs 9 mm/h), and platelet count (291 vs 221 × 10⁹/L). Pulmonary artery wall thickening was more common in active group (51.72% vs 11.43%). These parameters were restored after treatment. The incidence of pulmonary hypertension was comparable between groups (34.48% vs 51.43%), but patients in active group had lower pulmonary vascular resistance (PVR) (361.0 vs 891.0 dyn·s·cm^-5) and higher cardiac index (2.76 ± 0.72 vs 2.01 ± 0.58 L/min/m²). On multivariate logistic regression analysis, chest pain [odds ratio (OR) 9.37, 95%CI (1.98-44.38), P = 0.005], increased platelet count (>242.5 × 10⁹/L) [OR 9.03, 95%CI (2.10-38.87), P = 0.003] and pulmonary artery wall thickening [OR 7.08, 95%CI (1.44-34.89), P = 0.016] were independently associated with disease activity.

CONCLUSION

Chest pain, increased platelet count, and pulmonary artery wall thickening are potential new indicators of disease activity in PTA. Patients in active stage may have lower PVR and better right heart function.

Takayasu arteritis presenting with Fever of unknown origin: two case reports

Two patients with Takayasu arteritis are reported who presented with fever of unknown origin. Takayasu arteritis was diagnosed at the prepulseless period after stenotic lesions of the aorta, and its branches were seen with imaging methods. In the first month of steroid treatment, hypertension developed in both patients that was related to fibrosis in stenotic lesions in renal arteries. Both patients were treated with percutaneous transfemoral renal angioplasty. Takayasu arteritis should be considered in the differential diagnosis of fever of unknown origin, especially in young women. Absence of the physical findings related to vasculitic lesions will not rule out the disease, which can be seen in the prepulseless period.

Bronchiectasis and hoarseness of voice in takayasu arteritis: a rare presentation

BACKGROUND

Takayasu arteritis is a large vessel vasculitis occurring in young females. We report a rare presentation of Takayasu arteritis in a Sri Lankan woman. She presented with bronchiectasis and left recurrent laryngeal nerve palsy prior to the onset of vascular symptoms. This case illustrates an atypical presentation of this disease and the diagnostic dilemma that the physician may be faced with.

CASE PRESENTATION

A 39-year-old woman presented with chronic cough, haemoptysis and hoarseness of voice. She had left recurrent laryngeal nerve palsy and high inflammatory markers on investigation. CT thorax revealed aortic wall thickening and traction bronchiectasis. 2 D echocardiogram revealed grade 1 aortic regurgitation compatible with aortitis. She did not have weak peripheral pulses or a blood pressure discrepancy and did not meet American College of Rheumatology (ACR) criteria for diagnosis of Takayasu arteritis at this stage. Tuberculosis, syphilis and sarcoidosis was excluded. While awaiting angiography, she developed left arm claudication and a pericardial effusion. Angiography revealed evidence of Takayasu arteritis and absence of flow in the left subclavian artery. Takayasu arteritis was diagnosed at this stage after a period of eight months from the onset of initial symptoms. She is currently on prednisolone, azathioprine and aspirin.

CONCLUSION

Bronchiectasis and recurrent laryngeal nerve palsy is a rare presentation of Takayasu arteritis. Atypical presentations can occur in Takayasu arteritis prior to the onset of vascular symptoms. Elevation of inflammatory markers are an early finding. A high degree of suspicion is needed to identify these patients in the early course of the disease.

Pericardial effusion as primary manifestation of Takayasu arteritis

Takayasu arteritis (TA) is a chronic vasculitis, affecting young women in 80-90% of cases with greatest prevalence in Asians. As exudative pericarditis is an extremely rare, but a possible manifestation of TA, we report on a young women who presented with recurrent febrile pericardial effusion as primary manifestation of TA.

[Myopericarditis during Horton disease]

INTRODUCTION

Myopericarditis is an rare form of Horton disease. We report two new cases.

METHOD

Two patients, more than 60-years-old, had developed global cardiac insufficiency with predominant left insufficiency, with physical alteration and biological inflammation. Echocardiography revealed a myopericarditis. Bacteriological explorations were all negative. In the two cases, temporal artery biopsy revealed giant cell arteritis. Treatment with oral corticosteroids improved biological and clinical symptoms.

CONCLUSION

Myopericarditis is a rare form of Horton disease. Classical clinical presentation is rarely associated. Temporal artery biopsy is essential in confirming and proposing a specific therapy, in order to prevent cardiovascular ischemic complications.