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Ariga H, Chino Y, Ojima T, Suzuki S, Okada K, Kashimura J. Takayasu's arteritis associated with Crohn's disease treated with infliximab. Clin J Gastroenterol 2024; 17:281-285. [PMID: 38180710 DOI: 10.1007/s12328-023-01904-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
A 23-year-old woman presented with fever, diarrhea, bloody stools, and arthralgia that did not improve despite previous treatments and was diagnosed with Crohn's disease. Remission was achieved after the introduction of infliximab, nutritional therapy, and 5-aminosalicylic acid treatment. However, the patient's blood sedimentation rate remained elevated without symptom recurrence, except for abdominal pain in the following year. Aortic wall thickening in the thoracic descending aorta was also observed on computed tomography. Accumulation in the thoracic descending aorta and abdominal aorta was confirmed using positron emission tomography-computed tomography. The patient was diagnosed with Takayasu's arteritis. The patient's abdominal symptoms resolved, and her blood sedimentation rate normalized after steroid administration.
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Affiliation(s)
- Hiroyuki Ariga
- Department of Gastroenterology, Mito Kyodo General Hospital, 3-2-7 Miya-Machi, Mito, Ibaraki, 310-0015, Japan.
| | - Yusuke Chino
- Department of Rheumatology, Mito Kyodo General Hospital, Mito, Japan
| | - Takeshi Ojima
- Department of Gastroenterology, Mito Kyodo General Hospital, 3-2-7 Miya-Machi, Mito, Ibaraki, 310-0015, Japan
| | - Satoshi Suzuki
- Department of Gastroenterology, Mito Kyodo General Hospital, 3-2-7 Miya-Machi, Mito, Ibaraki, 310-0015, Japan
| | - Kenta Okada
- Department of Gastroenterology, Mito Kyodo General Hospital, 3-2-7 Miya-Machi, Mito, Ibaraki, 310-0015, Japan
| | - Junya Kashimura
- Department of Gastroenterology, Mito Kyodo General Hospital, 3-2-7 Miya-Machi, Mito, Ibaraki, 310-0015, Japan
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Pujari S, S V, Manna S, Modrecha A, Bolia R. Pulseless Diarrhea: Crohn Disease in an Adolescent With Takayasu Arteritis. J Clin Rheumatol 2021; 27:S636-S638. [PMID: 33337812 DOI: 10.1097/rhu.0000000000001673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
| | - Venkatesh S
- Internal Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Sukdev Manna
- Internal Medicine, All India Institute of Medical Sciences, Rishikesh, India
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Coexistence of Takayasu's Arteritis in Patients with Inflammatory Bowel Diseases. Gastroenterol Res Pract 2021; 2021:8831867. [PMID: 33628228 PMCID: PMC7895552 DOI: 10.1155/2021/8831867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 12/04/2022] Open
Abstract
Background Takayasu's arteritis (TA) and inflammatory bowel disease (IBD) are chronic inflammatory granulomatous disorders that have rarely been concomitantly reported in case reports and small case series. Objective We report a series of seven cases of TA and IBD association in two referral centers with a comprehensive review of literature. Methods We analyzed retrospectively the electronic medical charts of TA-IBD patients at the University Hospital of São Paulo, Brazil, and at the Sheba Medical Center at Tel Aviv University, Israel. Results Overall, five patients had Crohn's disease (DC) and two had ulcerative colitis (UC), and they were mostly female and non-Asian. All patients developed IBD first and, subsequently, TA. Two underwent colectomy and one ileocecectomy due to IBD activity, while three required cardiovascular surgery due to TA activity. Most patients are currently in clinical remission of both diseases with conventional drug treatment. Conclusion Although the coexistence of TA and IBD is uncommon, both seem to be strongly associated through pathophysiological pathways.
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Lavie G, Zalmanovich A, Golan Y, Jonas Kimchi T, Barenboim E. Acute stroke revealing Takayasu's arteritis in a patient with Crohn's disease. Acta Clin Belg 2016; 71:250-2. [PMID: 27075786 DOI: 10.1080/17843286.2015.1105604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A 36-year-old Caucasian male with Crohn's disease exhibited acute ischaemic stroke as the first manifestation of Takayasu's arteritis. Stroke as the first clinical manifestation of Takayasu's arteritis has been rarely reported. Though rare in Western countries, Takayasu's arteritis should be considered as a possibility in young patients presenting with stroke. Both Takayasu's arteritis and Crohn's disease may increase the risk of ischaemic stroke. Furthermore, their coexistence is much higher than that expected by chance and suggest a pathophysiological link between these diseases.
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Kilic L, Kalyoncu U, Karadag O, Akdogan A, Dogan I, Bilgen SA, Kiraz S, Ertenli I. Inflammatory bowel diseases and Takayasu's arteritis: coincidence or association? Int J Rheum Dis 2016; 19:814-8. [PMID: 26913584 DOI: 10.1111/1756-185x.12837] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Takayasu's arteritis (TA) and inflammatory bowel disease (IBD) are rare diseases but there are case reports presenting their co-existence in the literature. The aim of this study was to investigate the relation between IBD and TA. METHODS We studied 52 consecutive TA patients (90.3% female); medical records of the patients were analyzed retrospectively and serum samples were taken during the control visits for anti-neutrophil cytoplasmic antibody (ANCA) and anti-saccharomyces antibody (ASCA) tests. RESULTS Overall three (5.8%) of 52 patients had both IBD and TA. All were first diagnosed as IBD and the period between the diagnosis of IBD and TA was 9, 30 and 60 months, respectively. The age at diagnosis of TA was younger for the patients with IBD as compared to TA patients without IBD, but the difference was not statistically significant. Two patients had type-5 and one had type-2a TA. In 92 participants (52 with TA and 40 healthy controls) none had positive results for ANCA or ASCA. CONCLUSION Anti-saccharomyces antibody and ANCA tests are not useful for predicting the association between TA and IBD. On the other hand, both diseases have similar patient characteristics and pathophysiology which make us suspect that there may be an interaction. If a patient with IBD under immunosuppressive treatment has ongoing symptoms such as fever, weight loss, hypertension or high acute phase reactants, TA may be the cause. Further trials are needed but their coexistence cannot be explained as incidental.
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Affiliation(s)
- Levent Kilic
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Umut Kalyoncu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Akdogan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ismail Dogan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sule Apras Bilgen
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sedat Kiraz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ihsan Ertenli
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Kiyohara H, Hisamatsu T, Matsuoka K, Naganuma M, Kameda H, Seta N, Takeuchi T, Kanai T. Crohn's Disease in which the Patient Developed Aortitis during Treatment with Adalimumab. Intern Med 2015; 54:1725-32. [PMID: 26179525 DOI: 10.2169/internalmedicine.54.3853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 23-year-old woman developed aortitis during treatment with adalimumab (ADA) for ileocolic Crohn's disease (CD). The patient complained of a high fever, abdominal pain, diarrhea, hematochezia and arthralgia. Although the ADA therapy resulted in immediate symptom improvement, after six weeks, she again complained of a low-grade fever and abdominal pain, whereas the CD-related symptoms did not worsen. Contrast-enhanced computed tomography revealed thoracoabdominal aortitis, and we therefore started treatment with prednisolone, which immediately improved the fever and abdominal pain. We subsequently tapered the dose of prednisolone and resumed the administration of ADA in order to maintain the CD remission. No further episodes of aortitis relapse were noted after restarting ADA, and the CD currently remains in remission. This is the first report of the onset of aortitis during ADA therapy for CD.
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Affiliation(s)
- Hiroki Kiyohara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Japan
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Yilmaz N, Can M, Alibaz-Oner F, Direskeneli H. Clinically silent Crohn's disease in a patient with Takayasu's arteritis unresponsive to conventional therapies. Rheumatol Int 2012; 33:3091-3. [PMID: 23143554 DOI: 10.1007/s00296-012-2558-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 10/21/2012] [Indexed: 11/30/2022]
Abstract
Takayasu arteritis (TA) and Crohn's disease (CD) are chronic inflammatory diseases with granulomatous nature. Here, we report a case of TA with a silent course of CD who was refractory to corticosteroid and immunosuppressive treatments and improved with adalimumab therapy.
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Affiliation(s)
- Neslihan Yilmaz
- Department of Rheumatology, Faculty of Medicine, Marmara University, Fevzi Cakmak Mah, Ust Kaynarca / Pendik, Istanbul, Turkey,
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Hokama A, Kishimoto K, Ihama Y, Kobashigawa C, Nakamoto M, Hirata T, Kinjo N, Higa F, Tateyama M, Kinjo F, Iseki K, Kato S, Fujita J. Endoscopic and radiographic features of gastrointestinal involvement in vasculitis. World J Gastrointest Endosc 2012; 4:50-6. [PMID: 22442741 PMCID: PMC3309893 DOI: 10.4253/wjge.v4.i3.50] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 11/04/2011] [Accepted: 03/01/2012] [Indexed: 02/05/2023] Open
Abstract
Vasculitis is an inflammation of vessel walls, followed by alteration of the blood flow and damage to the dependent organ. Vasculitis can cause local or diffuse pathologic changes in the gastrointestinal (GI) tract. The variety of GI lesions includes ulcer, submucosal edema, hemorrhage, paralytic ileus, mesenteric ischemia, bowel obstruction, and life-threatening perforation.The endoscopic and radiographic features of GI involvement in vasculitisare reviewed with the emphasis on small-vessel vasculitis by presenting our typical cases, including Churg-Strauss syndrome, Henoch-Schönlein purpura, systemic lupus erythematosus, and Behçet’s disease. Important endoscopic features are ischemic enterocolitis and ulcer. Characteristic computed tomographic findings include bowel wall thickening with the target sign and engorgement of mesenteric vessels with comb sign. Knowledge of endoscopic and radiographic GI manifestations can help make an early diagnosis and establish treatment strategy.
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Affiliation(s)
- Akira Hokama
- Akira Hokama, Kazuto Kishimoto, Yasushi Ihama, Tetsuo Hirata, Futoshi Higa, Masao Tateyama, Jiro Fujita, Department of Infectious, Respiratory and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa 903-0125, Japan
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Rustagi T, Majumder S. Crohn's-Takayasu's arteritis overlap with hypercoagulability: an optimal milieu for ischemic stroke. J Dig Dis 2011; 12:142-6. [PMID: 21401901 DOI: 10.1111/j.1751-2980.2011.00479.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Tarun Rustagi
- Department of Internal Medicine, University of Connecticut, Connecticut 06032, USA.
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Osman M, Aaron S, Noga M, Yacyshyn E. Takayasu's arteritis progression on anti-TNF biologics: a case series. Clin Rheumatol 2011; 30:703-6. [PMID: 21221688 DOI: 10.1007/s10067-010-1658-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 12/07/2010] [Accepted: 12/08/2010] [Indexed: 01/26/2023]
Abstract
Takayasu's arteritis (TA) is a rare granulomatous vasculitic disease that affects the aorta and its major branches. Recent studies have suggested that anti-TNFα biological therapies are highly effective in treating TA refractory to conventional immunosuppressive therapy. We describe two patients with TA: one with progressive TA despite management with two different anti-TNFα agents, infliximab and adalimumab, and another who developed TA while treated with infliximab for the management of pre-existing Crohn's disease. From our observations, we believe that a multicentered randomized study should be designed to assess the extent of resistance to these agents when different therapeutic doses are employed for managing TA.
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Affiliation(s)
- Mohammed Osman
- Division of Rheumatology, Department of Medicine, 562 HMRC University of Alberta, T6G 2S2, Edmonton, Alberta, Canada
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Kusunoki R, Ishihara S, Sato M, Sumita Y, Mishima Y, Okada M, Tada Y, Oka A, Fukuba N, Oshima N, Moriyama I, Yuki T, Sato S, Amano Y, Murakawa Y, Kinoshita Y. Rare case of Takayasu's arteritis associated with Crohn's disease. Intern Med 2011; 50:1581-5. [PMID: 21804285 DOI: 10.2169/internalmedicine.50.5406] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Takayasu's arteritis (TA) and Crohn's disease (CD) are chronic inflammatory diseases of uncertain etiology. Although co-existence of these rare diseases is estimated to occur in 1 in 10 billion individuals, a theoretically unexpected association has been reported in several patients and it is suggested that those associations may have been more than an unusual coincidence. Herein, we report a case of TA associated with clinically inactive CD. A Japanese woman was diagnosed with colonic CD at the age of 15, developed aortic valve regurgitation at 19, and then presented with general fatigue, low grade fever, and painful sensations in her left arm at 25. She was diagnosed with TA based on computed tomography scanning and magnetic resonance angiography findings, and treatments with prednisolone and cyclosporine were started. Thereafter, valve replacement and right coronary artery bypass graft surgery were performed. The possible pathophysiological mechanism responsible for concurrent existence of TA and CD may be associated with immune disorders. Early diagnosis of vascular lesions for patients with inflammatory bowel disease is highly encouraged.
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Affiliation(s)
- Ryusaku Kusunoki
- Department of Internal Medicine II, Shimane University School of Medicine, Japan
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Large-vessel granulomatous vasculitis in Crohn's disease: a clinical pathology conference held by the division of rheumatology at hospital for special surgery. HSS J 2010; 6:206-13. [PMID: 21886537 PMCID: PMC2926363 DOI: 10.1007/s11420-010-9177-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 06/16/2010] [Indexed: 02/07/2023]
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Arnaud L, Haroche J, Limal N, Toledano D, Gambotti L, Chalumeau NC, Boutin DLTH, Cacoub P, Cluzel P, Koskas F, Kieffer E, Piette JC, Amoura Z. Takayasu arteritis in France: a single-center retrospective study of 82 cases comparing white, North African, and black patients. Medicine (Baltimore) 2010; 89:1-17. [PMID: 20075700 DOI: 10.1097/md.0b013e3181cba0a3] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We conducted a single-center retrospective study to compare the characteristics of Takayasu arteritis (TA) among white, North African, and black patients in a French tertiary care center (Hospital Pitié-Salpêtrière, Paris). Eighty-two patients were studied (82.9% female) during a median follow-up of 5.1 years (range, 1 mo to 30 yr). Among these 82 patients, 39 (47.6%) were white, 20 (24.4%) were North African, and 20 (24.4%) were black patients. Median age at diagnosis was 39.3 years (range, 14-70 yr) in white patients vs. 28.4 years (range, 12-54 yr) in North African (p = 0.02), and 28.0 years (range, 13-60 yr) in black patients (p = 0.08). Patients aged >40 years at TA onset were more frequently white than non-white (40.0% vs. 18.6%, p = 0.03). North African patients had more frequent occurrence of ischemic stroke (p = 0.03) and poorer survival (p = 0.01) than white patients. Type V of the Hata classification was the most frequent type among white (38.5%), North African (65.0%), and black patients (40.0%). Corticosteroids were used in 96.1% of patients. Fifty-three percent of white and North African patients, and 44% of black patients required a second line of immunosuppressive treatment (p = 0.60). Vascular surgical procedures were respectively performed in 46.1%, 50.0%, and 55.0% of white, North African, and black patients, p = 0.81. The 5-year and 10-year survival rates were 100% and 95.0%, respectively, in white patients; 67.4% at both 5 years and 10 years in North African patients; and 100% at both 5 years and 10 years in black patients. This study is one of the first direct comparisons of TA profiles among patients of distinct ethnic backgrounds. Our data support the idea that late-onset TA or an overlap between TA and large-vessel giant cell arteritis may be observed in white patients. North African patients have a higher occurrence of ischemic stroke and poorer survival than white patients.
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Affiliation(s)
- Laurent Arnaud
- From Service de Médecine Interne (LA, JH, NL, NCC, DB, P Cacoub, JCP, ZA), Service de Radiologie (DT, P Cluzel), Service de Santé Publique (LG), and Service de Chirurgie Vasculaire (FK, EK); and Hôpital Pitié-Salpêtrière, AP-HP, Université Paris 6, Paris, France
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Katoh N, Kubota M, Shimojima Y, Ishii W, Matsuda M, Akamatsu T, Ikeda SI. Takayasu's arteritis in a patient with Crohn's disease: an unexpected association during infliximab therapy. Intern Med 2010; 49:179-82. [PMID: 20075586 DOI: 10.2169/internalmedicine.49.2491] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We report a 20-year-old woman with Crohn's disease (CD) who developed anterior neck pain while being treated with the anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, infliximab. She showed no symptoms suggestive of active CD except for tenderness along the left common carotid artery with marked increases in serum TNF-alpha and inflammatory reactions. Based on thickened walls of large vessels with enhancement effects on computed tomography, she was diagnosed as having associated Takayasu's arteritis (TA), which was successfully treated with corticosteroid. Even if CD is controlled by infliximab, other autoimmune disorders, such as TA, may develop as a complication.
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Affiliation(s)
- Nagaaki Katoh
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, and Department of Endoscopy, Shinshu University Hospital, Matsumoto
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Abstract
A arterite de Takayasu e a doença de Crohn são doenças inflamatórias com etiologia desconhecida. Raramente ocorrem de modo concomitante em um mesmo indivíduo, havendo menos de 30 casos relatados na literatura. Este trabalho descreve essa associação em uma paciente de 36 anos de idade portadora de doença de Crohn, que apresentou redução dos pulsos no membro superior esquerdo e pressão arterial de 60/40 mmHg. A angiotomografia evidenciou estenose segmentar de artéria subclávia esquerda e espessamento parietal circunferencial da aorta na transição toracoabdominal entre T10 e L1, estabelecendo o diagnóstico de arterite de Takayasu. Ambas as patologias são mediadas imunologicamente e apresentam granulomas e vasculite granulomatosa, o que contribui para reforçar a hipótese de uma origem imunológica comum no seu desenvolvimento. Acreditamos que este seja o primeiro caso relatado na literatura brasileira da presença concomitante destas duas enfermidades.
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Ashraf S, Alkarawi MA, Alokaily F, Alkhushail A, Alrobayan A. Takayasu's arteritis associated with Crohn's disease: a case report and literature review. BMJ Case Rep 2009; 2009:bcr07.2008.0490. [PMID: 21686781 DOI: 10.1136/bcr.07.2008.0490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Takayasu's arteritis and inflammatory bowel disease are rarely found together, although the number of cases reported in the literature is increasing. Takayasu's arteritis has been studied in 31 patients from the Arab world but in none of them was it associated with Crohn's disease. We report the case of a Saudi woman previously diagnosed with Crohn's disease who subsequently developed Takayasu's arteritis, which may represent one of many extra-intestinal manifestations of inflammatory bowel disease. The possible aetiological factors, diagnostic methods, differential diagnoses and common pathophysiological mechanisms of the two diseases are discussed. This is the first case report of these two diseases in an Arab patient.
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Affiliation(s)
- Sohail Ashraf
- Riyadh Armed Forces Hospital, Gastroenterology, B-87 PO Box 7897, Riyadh 11159, Saudi Arabia
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