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

Anusha C Jayasinghe,Aruna Kulatunga,Gamage ND Perera,Lalindra D Dias

doi:10.1186/1756-0500-5-447

Abstract

BackgroundTakayasu 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 presentationA 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.ConclusionBronchiectasis 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.

Highlights

Takayasu arteritis is a large vessel vasculitis occurring in young females
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

Summary

Conclusion

Bronchiectasis and recurrent laryngeal nerve palsy is a rare presentation of Takayasu arteritis. It is difficult to identify patients with these atypical presentations and to differentiate from diseases with similar manifestations. Thrombocytosis and elevation of inflammatory markers are early findings which should prompt the clinician to search for evidence of Takayasu arteritis with appropriate imaging modalities. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Authors’ contribution GP is the first author and wrote the manuscript. DJ and LD was involved in patient management and in writing the article. AK was responsible for overall management of the patient and supervised the writing critically. All the authors have made significant contributions for this manuscript. All authors read and approved the final manuscript

Background

Discussion