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Thomas KN, Aggarwal A. Childhood rheumatic diseases: bites not only the joint, but also the heart. Clin Rheumatol 2023; 42:2703-2715. [PMID: 37160484 PMCID: PMC10169151 DOI: 10.1007/s10067-023-06621-9] [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] [Received: 12/27/2022] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
Cardiovascular involvement in juvenile rheumatic diseases is the primary manifestation in paediatric vasculitis and a major organ manifestation in paediatric connective tissue diseases. Though coronary vasculitis is the prototypical manifestation of Kawasaki disease, it can also be seen in patients with polyarteritis nodosa. Pericarditis is the most common manifestation seen in juvenile rheumatic diseases like systemic onset JIA, and lupus. Cardiac tamponade, valvular insufficiency, aortic root dilatation and arrhythmias are seen rarely. Cardiac involvement is often recognized late in children. The development of cardiac disease in juvenile systemic sclerosis is associated with a poor outcome. In long term, childhood onset of rheumatic diseases predisposes to diastolic dysfunction and premature atherosclerosis during adulthood. Key Points • Pericarditis is the most common cardiac manifestation in SLE and can lead to tamponade. • Conduction defects are common in juvenile mixed connective tissue disease and systemic sclerosis. • Pulmonary hypertension is a significant contributor to mortality in juvenile systemic sclerosis. • In Kawasaki disease, early treatment can reduce risk of coronary artery aneurysms.
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Affiliation(s)
- Koshy Nithin Thomas
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
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Clemente G, Silva CA, Sacchetti SB, Ferriani VPL, Oliveira SK, Sztajnbok F, Bica BERG, Cavalcanti A, Robazzi T, Bandeira M, Terreri MT. Takayasu arteritis in childhood: misdiagnoses at disease onset and associated diseases. Rheumatol Int 2018; 38:1089-1094. [PMID: 29687155 DOI: 10.1007/s00296-018-4030-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/12/2018] [Indexed: 11/24/2022]
Abstract
Juvenile-Takayasu arteritis (j-TA) is a difficult diagnosis and some patients develop uncommon manifestations and associated diseases that may contribute to the delayed diagnosis. Our aim was to identify the misdiagnoses, the associated diseases and the atypical manifestations observed in a j-TA Brazilian multicentre study. 71 children and adolescents who met the classification criteria for j-TA were included. The misdiagnoses, the associated diseases and the atypical manifestations were evaluated. 19 (26.8%) patients had misdiagnoses. The most common of them was aortic coarctation in six (8.4%) patients, followed by rheumatic fever in five (7.0%) and one patient presented with both former diagnoses. Limb pain (two patients), spondyloarthropathy, juvenile idiopathic arthritis (JIA), spinal arteriovenous malformation, polyarteritis nodosa (PAN) and fever of unknown origin (FUO) were other misdiagnoses. Patients who had misdiagnoses previously to j-TA diagnosis presented a trend to have a longer diagnosis delay. 11 (15.5%) patients had 14 TA-associated diseases, such as pulmonary tuberculosis (5 patients), rheumatic fever (2 patients), spondyloarthropathy, polyarticular JIA, Crohn's disease, Prader-Willi disease, diabetes mellitus, Moyamoya and primary immunodeficiency. 7 (9.9%) patients presented 10 atypical manifestations, such as pyoderma gangrenosum, erythema nodosum, myositis, chorea, enthesitis, episcleritis, uveitis, hepatomegaly, splenomegaly and necrosis of extremities. Our study emphasizes the main misdiagnoses, associated diseases and atypical manifestations that occur in patients with j-TA and warns of the features that may alert paediatricians to this diagnosis, such as constitutional symptoms and elevated inflammatory markers.
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Affiliation(s)
- Gleice Clemente
- Pediatrics Rheumatoloy Unit, Department of Pediatrics, São Paulo Federal University, São Paulo, SP, Brazil.
| | - Clovis A Silva
- Pediatrics Rheumatology Unit, Children's Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Silvana B Sacchetti
- Pediatrics Rheumatology Unit, Pediatric Department of Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Virginia P L Ferriani
- Pediatrics Rheumatology Division, Department of Pediatrics, Ribeirao Preto Medical School, Sao Paulo University, Ribeirao Preto, SP, Brazil
| | - Sheila K Oliveira
- Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, RJ, Brazil
| | - Flavio Sztajnbok
- Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, RJ, Brazil
| | - Blanca E R G Bica
- Hospital Universitário Clementino Fraga Filho-Rheumatology Division-Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil
| | - André Cavalcanti
- Pediatrics Rheumatology Unit, Department of Materno-Infantil, Federal University of Pernambuco, Recife, PE, Brazil
| | - Teresa Robazzi
- Pediatrics Rheumatology Unit, Bahia Federal University, Salvador, BA, Brazil
| | | | - Maria Teresa Terreri
- Pediatrics Rheumatoloy Unit, Department of Pediatrics, São Paulo Federal University, São Paulo, SP, Brazil
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Firdouse M, Agarwal A, Mondal T. Vein of Galen arteriovenous malformation mimicking coarctation of the aorta. J Ultrasound 2014; 17:297-301. [PMID: 25368688 DOI: 10.1007/s40477-014-0080-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/06/2014] [Indexed: 11/25/2022] Open
Abstract
Arteriovenous malformation of the vein of Galen is a rare congenital intracranial anomaly lacking a capillary bed and subsequent aneurysmal enlargement of the arterial and venous system, warranting careful management due to associated morbidity and mortality. Coarctations of aorta demonstrate similar neonatal echocardiographic signs to the vein of Galen arterial malformation (VGAM). We present a boy at 37 weeks of gestation whose initial ultrasound and echocardiographic investigations showed a dominant right ventricle and isthmal hypoplasia, suggestive of coarctation of aorta. Follow-up ultrasound and echocardiography revealed an arteriovenous malformation involving middle and posterior cerebral artery branches, eliminating coarctation of aorta. VGAM was confirmed by further ultrasound and angiographic investigation, which demonstrated a tangle of cerebral and choroidal arterial branches centrally feeding into an enlarged vein of Galen. The boy's hemodynamic and neurological statuses were confirmed to be stable despite increased venous pressure. Elective embolization at 7 months of age was complicated by a cerebrovascular accident, resulting in right hemiparesis despite no residual cardiac issues. This case demonstrates that rarely, arteriovenous malformations such as the vein of Galen malformations may be the primary cause of patients presenting with coarctation of aorta. The rarity of this condition and its guarded prognosis make our case of special interest to cardiologists and the perinatal care team.
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Affiliation(s)
- Mohammed Firdouse
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada ; Bachelor of Health Sciences (B.H.Sc. Honours) Program, McMaster University, 4077 Tea Garden Circle, Mississauga, ON L5B 2W5 Canada
| | - Arnav Agarwal
- Faculty of Health Sciences, McMaster University, Hamilton, ON Canada ; Bachelor of Health Sciences (B.H.Sc. Honours) Program, McMaster University, 252 Macedonia Crescent, Mississauga, ON L5B 3R7 Canada
| | - Tapas Mondal
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
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Parent JJ, Bendaly EA, Hurwitz RA. Abdominal Coarctation and Associated Comorbidities in Children. CONGENIT HEART DIS 2013; 9:69-74. [DOI: 10.1111/chd.12082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2013] [Indexed: 10/26/2022]
Affiliation(s)
- John J. Parent
- Department of Pediatric Cardiology; Indiana University School of Medicine; Indianapolis Ind USA
| | - Edgard A. Bendaly
- Department of Pediatric Cardiology; Sanford Children's Hospital; Sioux Falls S. Dak USA
| | - Roger A. Hurwitz
- Department of Pediatric Cardiology; Indiana University School of Medicine; Indianapolis Ind USA
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Coarctation of the aorta and vein of Galen malformation - treatment considerations in a severely compromised patient. Cardiol Young 2012; 22:596-9. [PMID: 22166766 DOI: 10.1017/s104795111100196x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A vein of Galen malformation - a rare cause of cardiac insufficiency in neonates - is sometimes associated with coarctation of the aorta, two diseases requiring urgent therapy in the neonatal period. We report on a term neonate in whom we first palliated the coarctation by stent implantation, providing time to treat the vein of Galen malformation by endovascular embolisation. Following this, the coarctation was surgically repaired and the stent was explanted.
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