The Coexistence of Crohnʼs Disease and Takayasu Arteritis

Abstract

Purpose: Crohn's disease is an inflammatory bowel disease classically causing granulomatous, transmural inflammation of the bowel wall, producing abdominal pain, obstruction, and fistula formation. Takayasu arteritis is a chronic granulomatous vasculitis that causes inflammation and stenosis of large and medium-sized arteries including the aorta and its primary branches. The purpose of this case series is to describe three cases of coexisting Crohn's disease and Takayasu arteritis and the response to anti-tumor necrosis factor therapy at a tertiary care medical center. Methods: A case series design was used. Results: We report on three patients with coexisting Crohn's disease and Takayasu arteritis. The diagnosis of Crohn's disease was made by combining patient symptoms, laboratory data, radiographic imaging, endoscopic evaluation and pathological evaluation of luminal mucosal biopsy. All of these patients also met classification criteria for Takayasu arteritis as defined by the American College of Rheumatology. Unique to this case report is the treatment of these patients with infliximab for their combined disease. All three patients experienced successful control of symptoms related to Crohn's disease and Takayasu arteritis after treatment with infliximab. Conclusion: Evidence is building in the medical literature for a subgroup of patients with coexisting Crohn's disease and Takayasu arteritis. A common autoimmune etiology has been hypothesized. The three patients in this report received infliximab therapy, which has previously not been described in the literature as treatment for patients with these combined diseases. The similarities in pathophysiology of these diseases allow exploration into the role of biologic agents as therapy for patients who have coexisting Crohn's disease and Takayasu arteritis.Figure: Coronal CT enterography (left) with fused FDG PET-CT image (right): White arrowheads show areas of active Crohn's disease, with intense FDG uptake, wall thickening and mucosal enhancement on CT. Black arrowhead shows abnormal FDG uptake (yellow area) in the distal aorta related to Takayasu arteritis.