[Takayasu arteritis]

Takayasu's arteritis in an adolescent with fever of unknown origin: the contribution of PET-CT in the diagnosis

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.

Chronic dissection of the abdominal aorta as a rare complication of Takayasu disease

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.

Pregnancy Morbidities in Korean Patients with Takayasu Arteritis: A Monocentric Pilot Study

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.

[Dissection of the abdominal aorta revealing Takayasu´s disease: about a case in Guinea]

La maladie de Takayasu (MT) est une artériopathie inflammatoire chronique touchant l´aorte, ses principales branches et les artères pulmonaires. Son appellation tient de l´ophtalmologiste japonais Mikito Takayasu qui publia en 1908 la première description de la maladie. Il s´agissait d´un patient de 78ans admis pour douleur abdominale, douleur du membre inférieur droit à la marche, insomnie. Evoluant depuis 1an sans antécédent de maladie cardio-vasculaire connu. A l´examen physique: le rythme cardiaque régulier à 87 battements par minute sans bruits pathologiques surajoutés avec une absence de pouls pédieux droit, tension artérielle à 120/78 mmhg, poumons libres, abdomen souple avec une masse battante dans la fosse iliaque droite dont l´auscultation met en évidence un souffle continu. Le reste de l´examen est sans particularité. L´angioscanner abdominal confirmait un aspect de dissection aortique étendue sur l´ensemble de l´aorte abdominale avec opacification synchrone des deux chenaux, un anévrisme thrombosé des artères iliaques primitives mesurant 48mm x100mm à droite et 38mm x 90mm à gauche, absence de fissuration visible. Nous rapportons le cas d´une dissection de l´aorte abdominale associée à un anévrisme thrombosé des artères iliaques primitives révélant une maladie de Takayashu au service de cardiologie de l´hôpital national Ignace Deen. La fréquence de la dissection de l´aorte abdominale au cours de la maladie de Takayasu est rare. Elle est plus souvent diagnostiquée dans sa phase occlusive. Le pronostic dépend des complications évolutives.

A study on the risk factors of coronary artery disease in patients with Takayasu arteritis

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.

[Tocilizumab for refractory Takayasu arteritis with aortic aneurysm]

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).