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Adnan S, Nawab S, Khan SU, Hussain F. The enhanced reliability of higher national institute of health stroke scale thresholds over the conventional 6-point scale. Clin Neurol Neurosurg 2024; 241:108284. [PMID: 38663199 DOI: 10.1016/j.clineuro.2024.108284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION It is still uncertain if higher thresholds on National Institute of Health Stroke Scale (NIHSS) are better predictors of large infarctions than the conventional 6-point cutoff. METHODS We used 6-point and higher NIHSS thresholds including 8, 9, and 10-point to predict relative infarct areas, expressed as percentage of the affected hemisphere on axial brain computed tomography images, beginning at 5% with 5% increments each time until reaching the 40% cutoff for large infarctions, or achieving 100% sensitivity. Results were compared using area under the receiver operating characteristic curves (AUROC). RESULTS We enrolled 151 patients of acute ischemic stroke (Mean age: 62.88 years ± 12.71; Female: 48.34%). 77 patients (50.99%) exhibited left hemisphere strokes, while 74 (49%) had right hemisphere involvement. Sensitivity values of the 6-point for infarcts measuring 5%, 10%, 20%, 30%, and 40% were 62%, 64%, 77%, 82%, and 100%, respectively. At 40% infarct-size, 8-point achieved comparable results (52%, 55%, 69%, 76%, 100%), closely aligning with the 9-point (50%, 53%, 69%, 76%, 100%). The10-point was slightly trailing behind in sensitivity at 40% infarct-core (96%). Moreover, higher thresholds exhibited improved false-positive rates (FPR). At 40% infarct size, the FPRs of 6, 8, 9, and 10 points were 39%, 27%, 27%, and 21% respectively. Higher thresholds had augmented AUROC values (0.86, 0.86, 0.89) as compared to the 6-point (0.80). Logistic regression identified 14-point as definitive cutoff for large infarctions. CONCLUSION Higher thresholds can better differentiate small and medium infarcts as true-negatives and substantially reduce false-positive referrals for mechanical thrombectomy.
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Affiliation(s)
- Sohail Adnan
- District Headquarter Teaching Hospital KDA, Kohat, Pakistan.
| | - Sadaf Nawab
- Khyber Medical University, Institute of Medical Sciences (KMU-IMS), Kohat, Pakistan
| | | | - Farid Hussain
- District Headquarter Teaching Hospital KDA, Kohat, Pakistan
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Goncalves L, Tran VT, Chauffier J, Bourdin V, Nassarmadji K, Vanjak A, Bigot W, Burlacu R, Champion K, Lopes A, Depont A, Borrero BA, Mangin O, Adle-Biassette H, Bonnin P, Boutigny A, Bonnin S, Neumann L, Mouly S, Sène D, Comarmond C. [Clinical characteristics and follow-up of 60 patients with recent diagnosis of giant cell arteritis, NEWTON study]. Rev Med Interne 2024:S0248-8663(23)01322-X. [PMID: 38216390 DOI: 10.1016/j.revmed.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION The management of giant cell arteritis (GCA) has evolved with the arrival of tocilizumab (TCZ) and the use of PET/CT. Our objective is to describe the characteristics and followup of patients with recent diagnosis of GCA in current care. PATIENTS AND METHODS The NEWTON cohort is a monocentric retrospective cohort based on data collected from 60 GCA patients diagnosed between 2017 and 2022 according to the ACR/EULAR 2022 criteria. RESULTS The median age at diagnosis was 73 [68.75; 81] years old. At diagnosis, the main manifestations were unusual temporal headaches in 48 (80 %) and an inflammatory syndrome in 50 (83 %) patients. Temporal artery biopsy confirmed the diagnosis in 49/58 (84 %) patients. Doppler of the temporal arteries found a halo in 12/23 (52 %) patients. The PET/CT found hypermetabolism in 19/43 (44 %) patients. Prednisone was stopped in 17.5 [12.75; 24.25] months. During follow-up, 22 (37 %) patients received TCZ. At least one complication of corticosteroid therapy was observed in 22 (37 %) patients. After a median follow-up of 24 [12; 42] months, 25 (42 %) patients relapsed. At the end of the follow-up, 29 (48.3 %) patients were weaned from corticosteroid therapy and 15 (25 %) were on TCZ. CONCLUSION Despite the increasing use of TCZ in the therapeutic arsenal and of the PET/CT in the imaging tools of GCA patients, relapses and complications of corticosteroid therapy remain frequent, observed in more than a third of patients.
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Affiliation(s)
- L Goncalves
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - V-T Tran
- Centre d'épidémiologie clinique, hôpital Hôtel-Dieu, université Paris Cité, Paris, France
| | - J Chauffier
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - V Bourdin
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - K Nassarmadji
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - A Vanjak
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - W Bigot
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - R Burlacu
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - K Champion
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - A Lopes
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - A Depont
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - B A Borrero
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - O Mangin
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | | | - P Bonnin
- Physiologie, hôpital Lariboisière, Paris, France
| | - A Boutigny
- Physiologie, hôpital Lariboisière, Paris, France
| | - S Bonnin
- Ophtalmologie, hôpital Lariboisière et Fondation Rothschild, Paris, France
| | - L Neumann
- Neurologie, hôpital Lariboisière, Paris, France
| | - S Mouly
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - D Sène
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France
| | - C Comarmond
- Médecine interne, hôpital Lariboisière, université Paris Cité, Paris, France.
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Damughatla AR, Milan-Ortiz V, Koleti P, Milan-Ortiz MM, Pasham SR, Damughatla AR, Kamatham S, Bazzy K. Identifying the Cause of Acute Left-Sided Visual Loss: A Clinical Dilemma. J Med Cases 2023; 14:200-203. [PMID: 37435103 PMCID: PMC10332869 DOI: 10.14740/jmc4093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
Given the global increase in the incidence of head and neck cancers over the last decade, the use of chemoradiation has also increased. It is well known that chemotherapy/radiation are established standard therapies in head and neck cancers, especially in patients who are not candidates for surgery. Despite this increase in chemoradiation therapies in head and neck cancers, there is a lack of established guidelines on the surveillance and screening of these patients for long-term complications. We present an interesting case of acute left eye blindness in a veteran patient with a history of laryngeal cancer status post chemoradiation and in the setting of a left ventricular (LV) thrombus on anticoagulation resulting in a diagnostic challenge determining the etiology. This case emphasizes the need for thorough patient-centered annual evaluation, thus providing an opportunity for early noninvasive or minimally invasive intervention.
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Affiliation(s)
- Anirudh R. Damughatla
- Department of Internal Medicine, Wayne State University & Detroit Medical Center, Detroit, MI, USA
- Department of Internal Medicine, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Vanessa Milan-Ortiz
- Department of Internal Medicine, Wayne State University & Detroit Medical Center, Detroit, MI, USA
- Department of Internal Medicine, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Pragna Koleti
- Department of Internal Medicine, Suburban Community Hospital, Norristown, PA, USA
| | | | - Sudhir Reddy Pasham
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | | | - Saivaishnavi Kamatham
- Department of Internal Medicine, Wayne State University & Detroit Medical Center, Detroit, MI, USA
- Department of Internal Medicine, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Kareem Bazzy
- Department of Internal Medicine, Wayne State University & Detroit Medical Center, Detroit, MI, USA
- Department of Internal Medicine, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA
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Chang J, Bulwa Z, Breit H, Cherian LJ, Conners JJ, Song SY, Dafer RM. Acute Large Vessel Ischemic Stroke in Patients With COVID-19-Related Multisystem Inflammatory Syndrome. Pediatr Neurol 2022; 126:104-107. [PMID: 34768033 PMCID: PMC8464033 DOI: 10.1016/j.pediatrneurol.2021.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acute ischemic stroke (AIS) is rare in children, and diagnosis is often delayed. Neurological involvement may occur in multisystem inflammatory syndrome in children (MIS-C), but very few cases of AIS in patients with MIS-C have been reported. PATIENT DESCRIPTIONS We two patients with AIS presenting with large vessel occlusive disease in previously healthy adolescents recently exposed to SARS-CoV-2 infection. RESULTS Both patients were subsequently diagnosed with and treated for MIS-C. Here, we discuss the course of their treatments and clinical responses. CONCLUSION Early recognition and diagnosis of AIS with large vessel occlusion in children with MIS-C is critical to make available all treatment options to improve clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Rima M. Dafer
- Communications should be addressed to: Dr. Dafer; Professor of Neurology; Department of Neurological Sciences; Section of Cerebrovascular Disease; Rush University Medical Center; Professional Building, Suite 1118, 1725 W. Harrison St; Chicago, IL 60612
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Abstract
There are no universally accepted diagnostic criteria for large-vessel vasculitides (LVV), including giant cell arteritis (GCA) and Takayasu arteritis (TAK). Currently, available classification criteria cannot be used for the diagnosis of GCA and TAK. Early diagnosis of these two diseases is quite challenging in clinical practice and may be accomplished only by combining the patient symptoms, physical examination findings, blood test results, imaging findings, and biopsy results, if available. Awareness of red flags which lead the clinician to investigate TAK in a young patient with persistent systemic inflammation is helpful for the early diagnosis. It should be noted that clinical presentation may be highly variable in a subgroup of GCA patients with predominant large-vessel involvement (LVI) and without prominent cranial symptoms. Imaging modalities are especially helpful for the diagnosis of this subgroup. Differential diagnosis between older patients with TAK and this subgroup of GCA patients presenting with LVI may be difficult. Various pathologies may mimic LVV either by causing systemic inflammation and constitutional symptoms, or by causing lumen narrowing with or without aneurysm formation in the aorta and its branches. Differential diagnosis of aortitis is crucial. Infectious aortitis including mycotic aneurysms due to septicemia or endocarditis, as well as causes such as syphilis and mycobacterial infections should always be excluded. On the other hand, the presence of non-infectious aortitis is not unique for TAK and GCA. It should be noted that aortitis, other large-vessel involvement or both, may occasionally be seen in various other autoimmune pathologies including ANCA-positive vasculitides, Behçet's disease, ankylosing spondylitis, sarcoidosis, and Sjögren's syndrome. Besides, aortitis may be idiopathic and isolated. Atherosclerosis should always be considered in the differential diagnosis of LVV. Other pathologies which may mimic LVV include, but not limited to, congenital causes of aortic coarctation and middle aortic syndrome, immunoglobulin G4-related disease, and hereditary disorders of connective tissue such as Marfan syndrome and Ehler-Danlos syndrome.
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Snelling BM, Sur S, Shah SS, Chen S, Menaker SA, McCarthy DJ, Yavagal DR, Peterson EC, Starke RM. Unfavorable Vascular Anatomy Is Associated with Increased Revascularization Time and Worse Outcome in Anterior Circulation Thrombectomy. World Neurosurg 2018; 120:e976-83. [PMID: 30196176 DOI: 10.1016/j.wneu.2018.08.207] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Reperfusion time influences patient outcome in mechanical thrombectomy for large vessel occlusion. We analyzed anatomic features that could be used to make preoperative and intraoperative decisions to minimize revascularization time. METHODS We reviewed a prospectively maintained database for patients with stroke evaluated from February 2015 to July 2016. Patients received a score based on bovine arch, aortic arch, and internal carotid artery dolichoarteriopathy (B.A.D. score), which we correlated with procedural times and outcomes. Univariate analysis was performed to identify predictors of procedural times, revascularization, complications, and outcome. Relevant variables were assessed via multivariate regression. RESULTS We identified 61 patients (31 men) who underwent transfemoral thrombectomy. Mean puncture to reperfusion time was 46 minutes. Age >75 years (odds ratio [OR] = 3.98; 95% confidence interval [CI], 1.17-13.54; P = 0.027) and high B.A.D. score (OR = 2.55; 95% CI, 1.17-5.57; P = 0.019) were significant predictors of puncture to reperfusion time >40 minutes. Mean puncture to first-pass time was 24 ± 14.2 minutes. Age >65 years (OR = 4.68; 95% CI, 1.07-20.55; P = 0.041) and high B.A.D. score (OR = 2.84; 95% CI, 1.18-6.85; P = 0.020) were independently predictive of time to first pass >20 minutes. Lower scores predicted higher Thrombolysis In Cerebral Infarction score (OR = 0.07; 95% CI, 0.01-0.81; P = 0.033). Higher scores predicted hemorrhagic transformation (OR = 4.8; 95% CI, 1.19-12.29; P = 0.024) and modified Rankin Scale score >4 (OR = 3.0; 95% CI, 1.15-7.92; P = 0.025) after thrombectomy. CONCLUSIONS Bovine variation, aortic arch type, and internal carotid artery dolichoarteriopathy are associated with increased revascularization time and poor outcomes in thrombectomy. We developed the B.A.D. score to predict reperfusion time and outcomes, demonstrating need for preoperative anatomic evaluation to guide treatment.
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Wong SPY, Mok CC, Lau CS, Yip ML, Tam LS, Ying KY, Ng WL, Ng KH, Leung MH, Lee TY, To CH, Lee KL, Wan MC, Yu KL, Wong PCH, Sung CK, Lee KF, Kun EWL. Clinical presentation, treatment and outcome of Takayasu's arteritis in southern Chinese: a multicenter retrospective study. Rheumatol Int 2018; 38:2263-2270. [PMID: 30182290 DOI: 10.1007/s00296-018-4150-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/27/2018] [Indexed: 01/25/2023]
Abstract
To study the clinical presentation, treatment and outcome of southern Chinese patients with Takayasu's arteritis (TA). This is a retrospective chart review study of 78 patients managed in 14 public hospitals in Hong Kong between the years 2000 and 2010. Patients were identified from the hospital registry using the ICD-10 diagnostic code of the disease. The classification of TA was based on the American College of Rheumatology (ACR) or modified Ichikawa's criteria. Demographic data, clinical presentation, angiographic findings, pattern of vascular involvement (Numano's classification), treatment and outcome of these patients were presented. 78 patients were studied (82% women, age at presentation 34.2 ± 14 years). The estimated point prevalence of TA was 11/million population. The commonest initial manifestations were hypertension (62%) and vascular ischemic symptoms (38%). Systemic symptoms occurred in nine (12%) patients only. The proportion of patients fulfilling the angiographic subtypes of the Numano's classification was: types I (13%), IIa (4%), IIb (12%), III (12%), IV (20%) and V (39%), respectively. Thirty-two patients (41%) were treated with high-dose glucocorticoids (GCs) and 22 patients (28%) received additional non-GC immunosuppressive drugs. Vascular complications occurred in 26 (33%) patients and revascularization surgery was performed in 23(29%) patients. Three (4%) patients died of vascular complication at a median of 8 years after disease onset. TA is rare in southern Chinese patients of Hong Kong. Most patients present with ischemic symptoms during the stenotic phase of the disease. Although mortality is low, a significant proportion of patients developed vascular stenosis that required surgical interventions. More awareness of TA as a differential diagnosis of non-specific systemic symptoms with elevated inflammatory markers in younger patients is needed for earlier diagnosis.
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Affiliation(s)
- Stella Pui Yan Wong
- Department of Medicine, Tseung Kwan O Hospital, 2, Po Ning Lane, Hang Hau, Kowloon, Hong Kong SAR, China.
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
| | - Chak Sing Lau
- Department of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Man Lung Yip
- Tung Wah Groups of Hospital Integrated Diagnostic and Medical Centre, Kowloon, Hong Kong SAR, China
| | - Lai Shan Tam
- Department of Medicine & Therapeutics Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - King Yee Ying
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
| | - Woon Leung Ng
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Kam Hung Ng
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong SAR, China
| | - Moon Ho Leung
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Tsz Yan Lee
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Chi Hung To
- Department of Medicine, Pok Oi Hospital, Hong Kong SAR, China
| | - Ka Lai Lee
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Man Choi Wan
- Department of Medicine, Ruttonjee Hospital, Hong Kong SAR, China
| | - Ka Lung Yu
- Department of Medicine, Tuen Mun Hospital, Hong Kong SAR, China
| | - Priscilla Ching Han Wong
- Department of Medicine & Therapeutics Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China
| | - Chi Keung Sung
- Department of Medicine & Geriatrics, Tai Po Hospital, Hong Kong SAR, China
| | - Kwok Fai Lee
- Department of Medicine, Yan Chai Hospital, Hong Kong SAR, China
| | - Emily Wai Lin Kun
- Department of Medicine & Geriatrics, Tai Po Hospital, Hong Kong SAR, China
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Chandratilleke D, Anantharajah A, Vicaretti M, Benson W, Berglund LJ. Migratory large vessel vasculitis preceding acute myeloid leukemia: a case report. J Med Case Rep 2017; 11:71. [PMID: 28298242 PMCID: PMC5353784 DOI: 10.1186/s13256-017-1239-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/12/2017] [Indexed: 11/29/2022] Open
Abstract
Background Large vessel vasculitis is a rare disorder usually occurring in the context of the autoimmune conditions of giant cell arteritis and Takayasu’s arteritis. Case reports have described large vessel vasculitis occurring in individuals with myelodysplastic syndrome, preceding transformation to acute myeloid leukemia. Case presentation A 56-year-old Afghanistan-born woman presented with fever, a tender left carotid artery, and raised inflammatory markers. Computed tomography revealed thickening of the wall of her left carotid artery. Her symptoms resolved spontaneously; however, they recurred weeks later on the contralateral side, along with abdominal pain after eating. Further imaging with computed tomography and positron emission tomography demonstrated resolution of her left carotid artery abnormality, but new wall thickening and inflammation in her right carotid artery, abdominal aorta, and superior mesenteric artery. She was diagnosed as having large vessel vasculitis, which resolved with corticosteroids and methotrexate. Five months later, she developed acute myeloid leukemia. She had no known history of myelodysplastic syndrome at the time of diagnosis with vasculitis. Conclusions Large vessel vasculitis in older individuals presenting with atypical clinical features, such as a migratory pattern of affected vessels, vessel wall tenderness, and marked systemic inflammation, should prompt a search for underlying myelodysplasia. Clinicians should be vigilant for progression to acute myeloid leukemia.
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Affiliation(s)
- Dinusha Chandratilleke
- Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Sydney, 2145, NSW, Australia. .,Faculty of Medicine, University of Sydney, Sydney, NSW, 2000, Australia.
| | - Anthea Anantharajah
- Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Sydney, 2145, NSW, Australia
| | - Mauro Vicaretti
- Department of Vascular Surgery, Westmead Hospital, Sydney, 2145, NSW, Australia
| | - Warwick Benson
- Department of Haematology, Westmead Hospital, Sydney, 2145, NSW, Australia
| | - Lucinda J Berglund
- Department of Immunopathology, Pathology West, ICPMR, Westmead Hospital, Sydney, 2145, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, 2000, Australia
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Grewal GS, Leipsic J, Klinkhoff AV. Abdominal aortitis in HLA-B27+ spondyloarthritis: case report with 5-year follow-up and literature review. Semin Arthritis Rheum 2014; 44:305-8. [PMID: 24935530 DOI: 10.1016/j.semarthrit.2014.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/29/2014] [Accepted: 05/09/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Aortic disease is a known complication of HLA-B27-associated spondyloarthritis. We present the case of a 52-year-old HLA-B27-positive woman with aortitis of the abdominal aorta and spondyloarthritis. METHODS In addition to the case reported, a literature search (MEDLINE) for articles published between 1946 and September 2013 was performed using combinations of the MEDLINE subject headings keywords "spondylarthritis," "ankylosing spondylitis," "reactive arthritis," "psoriatic arthritis," "aortitis," and "abdominal aorta." Relevant references were retrieved. RESULTS CASE REPORT Our patient presented to the ER in June 2008 with a 3-week history of worsening of severe cramping lower abdominal pain. Her history also included recurrent acute episodes of iritis, which eventually led to enucleation of her left eye despite treatment with corticosteroids. CT of the abdomen showed findings suggesting aortitis of the abdominal aorta. She responded to therapy with prednisone, and follow-up imaging showed eventual resolution of the aortitis. She later went on to be diagnosed with psoriatic arthritis with spondylitis. REVIEW OF LITERATURE Six previously reported cases of abdominal aortitis in spondyloarthritis were found. Four of these were reported in patients with ankylosing spondylitis, one in reactive arthritis, and one in psoriatic arthritis. The first case reported was in 1958 and the most recent in 2012. CONCLUSIONS Rheumatologists should be aware of the possibility of abdominal aortitis occurring in their patients with SpA and should consider it as part of the differential diagnosis in a SpA patient with unexplained visceral pain or systemic features out of proportion to clinically apparent disease.
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Affiliation(s)
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alice V Klinkhoff
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
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