Case Of Takayasu Arteritis Research Articles

A case of Takayasu arteritis with normal coronary arteries presenting as stable angina

Takayasu arteritis (TAK) is a type of large vessel vasculitis characterized by granulomatous inflammation involving the aorta and its main branches. Clinical presentation may vary from non specific symptoms such as fever, malaise, weight loss to manifestations of organ hypo perfusion. Cardiac involvement may take forms of valvular insufficiency, angina or heart failure. In this case, we report a 39-year-old woman with hypertension presenting with angina, who was found to have multiple arterial bruits, with blood pressure and pulse volume discrepancies, aortic regurgitation and renovascular hypertension. She was diagnosed with Takayasu arteritis with clinical and imaging criteria; managed with glucocorticoid and DMARDS, achieving good clinical response and planned for surgical intervention for valvular insufficiency.

Takayasu arteritis with pulmonary artery involvement initially presenting as community-acquired pneumonia

The initial clinical manifestations of pulmonary artery involvement in Takayasu arteritis were complicated and non-specific, making early diagnosis difficult. Three cases of Takayasu arteritis with pulmonary artery involvement (TA-PAI) initially presenting as community-acquired pneumonia (CAP) were reported. The clinical characteristics and lab test results of the three cases were summarized, and the relevant literature on TA-PAI mimicking CAP was concomitantly reviewed. It might be helpful in the early recognition and diagnosis of such patients.

Successful Outcome of Pregnancy in two Cases of Takayasu Arteritis

Introduction : Takayasu arteritis is a vasculitis of unknown cause. It is a disease of involvement of vessels of branches of the aortic arch. It can affect women of reproductive age and may present with pregnancy. Pregnancy may have a favorable outcome if diagnosed and appropriately managed from the onset of the disease and enter pregnancy in the remission phase and with medication. But, if it is diagnosed for the first time during pregnancy outcome might be worse. Case reports: Here presented two case reports of diagnosed Takahashi Arteritis with term pregnancy; who entered pregnancy in remission phase and on medication. The prior preparation leads the pregnancy to a successful outcome without any residual effect on feto-maternal health. Conclusion: Early diagnosis of the disease and proper management of the progress of the disease by intervention is essential for a good prognosis. A close follow-up and multidisciplinary approach during pregnancy make pregnancy a safer journey for a woman with Takahashi Arteritis. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 63-67

Does Bronchial Artery Hypertrophies After Descending Thoracic Aorta Stenting in Takayasu Arteritis? - A Clinical Dilemma.

41-year-old lady, known case of Takayasu arteritis with pulmonary arterial involvement, presented with multiple episodes of haemoptysis (maximum 50mL) in a week. She had undergone descending thoracic aorta angioplasty and stenting 3years ago due to uncontrolled hypertension, left ventricular systolic dysfunction and approximately 70% stenosis of descending thoracic aorta. This lady was treated with embolization of hypertrophied bronchial artery as well as left internal mammary artery branch for management of haemoptysis. Embolization of hypertrophied bronchial artery in the setting of Takayasu arteritis with pulmonary arterial involvement presenting with haemoptysis is rare. Hypertrophied bronchial artery detected in post stenting computed tomography raises suspicion whether descending thoracic aorta stenting promotes the hypertrophy of bronchial artery. Literature of bronchial artery embolization in the setting of Takayasu with post DTA stenting is scarce.

More to it than meets the eye- A case of Takayasu arteritis and antiphospholipid syndrome, associated with ocular ischemic syndrome, neovascularization and secondary angle closure

We describe an atypical case of bilateral ocular ischemic syndrome with neovascularization and secondary angle closure in a 28-year-old lady with features of antiphospholipid syndrome (APS) and Takayasu arteritis; the latter being detected on evaluation of the etiology of the ocular condition. She was treated with pan retinal photocoagulation in one eye and anterior retinal cryotherapy in the other eye (due to poor visualization of the retina initially) followed by cataract surgery. Systemic evaluation was done. Takayasu arteritis was detected and appropriate management was advised under specialist care. Her systemic condition was stable, ocular neovascularization was regressing, and visual acuity improved in the pseudophakic eye; a drop in visual acuity due to the progression of cataract and macular ischemia was noted in the phakic eye at follow-up. Timely detection and appropriate management of ocular and systemic conditions in such cases can preserve vision and limit further systemic morbidity.

A Case of Takayasu Arteritis in a Male Patient

Takayasu arteritis (TA), otherwise called “pulseless disease”, is a category of primary systemic vasculitis involving medium and large arteries, including the aorta, its branches and the pulmonary and the coronary arteries. The presence of TA is often observed in women and the main population of patients develops their first symptoms between 15 years to 30 years. If left untreated, this disease may lead to the development of many comorbid renal and pulmonary obstructions causing lethal consequences. Here we present a case report of the diagnosis of TA in a 25-year-old male, treatment and following procedures. A patient with no anamnesis was hospitalized with paralysis of the right half of body and altered consciousness. He had been experiencing symptoms like fatigue, general weakness and respiratory distress for the past year. After extensive medical analysis patient was treated with oral prednisone and later endarterectomy was performed. After the operation, the patient improved and was discharged. Till date, no new complaints were reported.

Acute myocardial infarction with left main coronary artery ostial negative remodelling as the first manifestation of Takayasu arteritis: a case report

BackgroundTakayasu arteritis is a chronic inflammatory disease involving the aorta and its major branches. Acute myocardial infarction rarely but not so much presents in patients with Takayasu arteritis, and the preferable revascularization strategy is still under debate.Case presentationA 22-year-old female with Takayasu arteritis presented with acute myocardial infarction. Coronary angiography and intravenous ultrasound (IVUS) showed that the right coronary artery (RCA) was occluded and that there was severe negative remodelling at the ostium of the left main coronary artery (LMCA). The patient was treated by primary percutaneous transluminal coronary angioplasty (PTCA) with a scoring balloon in the LMCA, without stent implantation. After 3 months of immunosuppressive medication, the patient received RCA revascularization by stenting. There was progressive external elastic membrane (EEM) enlargement of the LMCA ostium demonstrated by IVUS at 3 and 15 months post-initial PTCA.ConclusionHere, we report a case of Takayasu arteritis with involvement of the coronary artery ostium. Through PTCA and long-term immunosuppressive medication, we found that coronary negative remodelling might be reversible in patients with Takayasu arteritis.

The author reply: Unusual Case of Takayasu Arteritis of the Superficial Femoral Arteries without Involvement of the Upper Extremities

The author reply: Unusual Case of Takayasu Arteritis of the Superficial Femoral Arteries without Involvement of the Upper Extremities

Takayasu arteritis in pregnancy: A case series

Takayasu arteritis is a disease of unknown etiology which is a primary systemic vasculitis leading to stenotic and occlusive changes. Takayasu arteritis is a chronic inflammatory disease in progressive pattern which chiefly affects the aorta and its main branches. The diagnosis of the disease is mainly based on the clinical suspicion, history, physical examination and vascular imaging. We present here three cases of takayasu arteritis in pregnancy that were treated at our institute in the last 5 years. 1st case had complications like severe preeclampsia, abruption, temporary loss of vision, and intra uterine death of fetus. In 2nd case there was brain sparing effect of fetus, but other than that she did not have any other complications and neonatal outcome was also good without any neonatal complications. In the 3rd case antenatal and postnatal periods were uneventful and with good neonatal outcome. Pregnancy with takayasu arteritis needs to be timely diagnosed and treated for best maternal and fetal outcome.

When Both the Right Ventricle and the Pulmonary Artery “Light Up”: A Case of Takayasu Arteritis

A 34-year-old woman with no significant past medical history was admitted to our hospital complaining of shortness of breath on exertion, which had worsened over the last 6 months, a fever of up to 37.5oC, malaise, and postural dizziness. Laboratory examination showed an erythrocyte sedimentation rate of 33 mm/hr, a C-reactive protein level of 5.1 mg/dL, and elevated N-terminal pro B-type natriuretic peptide (615 pg/mL). Transthoracic echocardiogram revealed a dilated and hypokinetic right ventricle, with impaired systolic function, and an estimated right ventricular systolic pressure of 65 mmHg (Videos S1 and S2).

AB1009 THE EFFICACY OF TOCILIZUMAB ON THE TREATMENT OF TAKAYASU ARTERITIS IN CHINESE CHILDREN

Background:Takayasu arteritis (TA) is the most prevalent large-vessel vasculitis in children. Patients with TA have a high mobidity and mortality.It remains a therapeutic challenge because corticosteroids monotherapy can rarely cure TAK and the relapse rate is high during GC tapering.Objectives:The aim of this study is to investigate the efficacy and safety of tocilizumab (TCZ)in Chinese children with Takayasu arteritis(TAK).Methods:We retrospectively studied 6 TAK children treated with TCZ in our hospital from July 2017 to October 2018. The demographic and clinical data, laboratory examination results and vascular imaging data were collected.Results:Six pediatric patients with critical or refractory TAK treated with TCZ were analyzed, including 3 males and 3 females.The diagnosis age was ranging in age from 2 to 13 years(median age:7 years).Three patients were initially treated with TCZ and Mycophenolate Mofetil(MMF) as the first-line regimen without corticosteroid or with a quite rapid GC taper duration,two of which had lifte-threatening coronary arteries involved and heart failure.The other three paitients were swcithed to TCZ from conventional disease modifying anti-rheumatic drugs (DMARDs) or other biologics due to being refractory to them and recurrent relapses.Four patients were given TCZ at 4 weeks regular intervals for 10 to 22 months,while two patients withdrew TCZ because of disease deterioration and unbearable abdominal or chest pain after the second dose.After 6 months follow-up,four patients experienced significant clinical and biological improvement with angiographically progression in one patient. A corticosteroid-sparing effect is obvious. Drug-related side effects occur in 1 patients manifesting as a mild elevated liver fuction. Neither neutropenia nor infection was observed.Conclusion:Our study shows a clinical, biological, and radiological response in patients with refractory TAK treated with TCZ.References :[1]Hellmich B, Agueda A, Monti S,et al.2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis 2019;0:1–12. doi:10.1136/annrheumdis-2019-215672.[2]BravoMancheño B, Perin F, Guez Vázquez Del ReyMDMR, García Sánchez A, Alcázar Romero PP. Successful tocilizumab treatment in a child with refractory Takayasu arteritis.Pediatrics 2012;130(6):e1720-724.[3]Goel R, Danda D, Kumar S, Joseph G. Rapid control of disease activity by tocilizumab in 10 «difficult-to-treat» cases of Takayasu arteritis. Int J Rheum Dis 2013;16(6):754–61.[4]Cañas CA, Cañas F, Izquierdo JH, Echeverri A-F, Mejía M, Bonilla-Abadía F, et al. Efficacy and safety of anti-interleukin 6 receptor monoclonal antibody (tocilizumab) in Colombian patients with Takayasu arteritis. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis 2014;20(3):125–9.[5]Batu ED, Sönmez HE, Hazirolan T, Özaltin F, Bilginer Y, Özen S. Tocilizumab treatment in childhood Takayasu arteritis: case series of four patients and systematic review of the literature. Semin Arthritis Rheum 2017 Feb;46(4):529–35.Disclosure of Interests:None declared

Novel ultrawide field fundus fluorescein angiographic findings in a patient of Takayasu arteritis on immunosuppression

A 35-year-old male, a case of Takayasu arteritis on treatment with oral prednisolone and methotrexate, revealed novel ultrawide field fluorescein angiographic features in bilateral eyes. The typical features of delayed arm-retina circulation time, lobulated areas of nonperfusion in choroid, cattle trucking of red blood cells in veins, and delayed arteriovenous transit time were nicely captured. Additionally, we noted peripheral perivascular hyperfluorescence and disc hyperfluorescence. We believe these findings could possibly be used as markers of disease activity. Lack of marked capillary nonperfusion areas and marked perivascular leakage probably signifies modulation of disease activity by the immunosuppressants.

Study on Serum Pentraxin-3 Levels in Vasculitis with Hypertension.

Pentraxin-3 (PTX-3) is derived from the secretion of macrophages, neutrophils, endothelial cells, epithelial cells, and vascular smooth muscle cells, which can regulate the immune activity of macrophages. The objectives of our study were to investigate the serum PTX-3 levels and analyze this correlation with vasculitis (Vas), with hypertension. A total of 155 cases consisting 51 patients with Vas [including 7 cases of takayasu arteritis (TA), 24 cases of polyarteritis nodosa (PAN), and 20 cases of antineutrophil cytoplasmic antibody-associated Vas (AAV)] were screened by angiography and/or biopsy; 46 patients with essential hypertensions (PH) and 58 healthy controls (HC) were enrolled in this study from January 2013 to December 2016. Serum PTX-3 levels were determined by enzyme-linked immunosorbent assay. Compared with the HC and PH, the serum PTX-3 levels in systemic Vas were significantly higher (both P < 0.001, 4.42 ± 0.95 vs. 2.67 ± 0.92 and 4.42 ± 0.95 vs. 2.95 ± 0.60), and there was no significant difference between HC and essential hypertension (P = 0.886, 2.67 ± 0.92 vs. 2.95 ± 0.60). There was no significant difference of PTX-3 levels among TA, PAN, and AAV, as well as active and inactive groups, and renal and nonrenal groups even if they had a significant difference from EH and HC, respectively. There was no significant correlation between PTX-3 levels and blood pressure, erythrocyte sedimentation rate, or Birmingham Vasculitis Activity Score. Receiver operating characteristic analysis has shown that the best cutoff point was at 3.618 ng/μL; the sensitivity and specificity were calculated as 84.3% and 93.5% for the diagnosis of Vas from heath control, and the best cutoff point was at 3.425 ng/μL, The sensitivity and specificity were calculated as 88.2% and 82.6% for the diagnosis of Vas from essential hypertension. Serum PTX-3 levels were significantly higher in patients with Vas than essential hypertension or health control, and elevated PTX-3 levels can help identify Vas patients from healthy or essential hypertensive populations.

Plasma infliximab monitoring contributes to optimize Takayasu arteritis treatment: a case report

BackgroundInfliximab (IFX), a mouse-human chimeric monoclonal antibody against human tumor necrosis factor alpha, is used in refractory cases of Takayasu arteritis. Several factors influence the pharmacokinetics of therapeutic antibodies including IFX. Monitoring plasma levels of IFX could be a useful approach in optimizing treatment via individual dose adjustment.Case presentationHere, we report the case of a 4-year-old Takayasu arteritis girl who was resistant to standard therapy. IFX was started at 5 mg/kg (day 0). C-reactive protein (CRP) levels decreased from 8.7 (day 0) to 1.6 mg/dL (day 10). CRP levels were thereafter elevated again on day 23 (9.0 mg/dL), and body fluid leakage at the inflammation site in the legs was observed. Trough IFX levels decreased from 23.6 (day 10) to 2.5 μg/mL (day 23). Based on the trough levels, IFX was given biweekly at 8 mg/kg. Plasma IFX levels gradually increased, and CRP levels decreased to around 2 mg/dL. A similar pattern -initial decreases followed by increases- was observed between clinical course of IFX and IgG levels. It was speculated that IgG and IFX losses were due to fluid leakage from the patient’s necrotizing legs.ConclusionsMonitoring of plasma IFX levels can be a potential tool to optimize the treatment in Takayasu arteritis patients.

A case of Takayasu arteritis in the early phase with ultrasound images similar to carotidynia

A case of Takayasu arteritis in the early phase with ultrasound images similar to carotidynia

Pulmonary cavities with Takayasu arteritis: report of 3 cases and literature review

Objective: To analyze the clinical features of 3 cases of Takayasu arteritis(TA) with pulmonary cavities on chest computed tomography(CT). Methods: The clinical data of 3 TA patients with cavities on the chest CT who were admitted into Beijing Chaoyang Hospital were retrospectively analyzed. A literature search was performed with "Takayasu arteritis" and "pulmonary" as the key words in China Knowledge Resource Intergrated Database (CNKI) and Pubmed Database for publications from Jan 1, 2000 to Dec. 31,2017. The relevant literatures were reviewed. Results: Among the 3 patients, 2 were males and 1 was female, aging 49, 28 and 28 years, respectively. They presented with cough, fever and chest pain, and chest CT showed cavities, single or multiple, either with thick or thin wall, or wedge-shaped consolidation, residual stripes after being absorbed, and one case had pulmonary biopsy results which showed hemorrhagic infarction. They were all misdiagnosed before as pneumonia, pulmonary tuberculosis, pulmonary thromboembolism. After being treated by combination therapy of glucocorticoids and immunosuppressive agents, the disease improved significantly. A total of 777 cases with TA involving pulmonary arteries were reported, from which 13 cases with involvement of pulmonary parenchyma were described. Therefore total 16 cases including the 3 cases in this article were included for analysis. Twelve cases showed patchy or wedge-shaped ground-glass opacity and consolidation, and peripheral lung stripes remained after being absorbed. Two cases showed pleural effusion, and 4 cases showed cavities, 3 cases were misdiagnosed as pulmonary tuberculosis, 7 as pulmonary infection, and 5 as pulmonary thromboembolism. Conclusions: TA with pulmonary arteries involved is susceptible to be misdiagnosed and missed, and therefore, in patients with cough, hemoptysis, chest pain and cavities in pulmonary parenchyma, TA should be suspected. Early diagnosis and appropriate treatment can lead to a better prognosis.

Takayasu arteritis in Umuahia, South East Nigeria

Takayasu arteritis is a rare, systemic inflammatory large vessel vasculitis of unknown etiology that predominantly affects women of childbearing age. It is defined as granulomatous inflammation of the aorta and its major branches. Although the disease has a worldwide distribution, it is observed more frequently in Asian countries. It is rare in the black race as only a few cases have been documented. The objective of this study is to present a case of Takayasu arteritis diagnosed in South East, Nigeria, which is a rare disease in blacks. A 34-year-old female with clinical and radiological features of Takayasu arteritis is presented and related literatures reviewed. Although Takayasu arteritis is rare in the black race, with heightened clinical suspicion and appropriate investigations, more cases may be diagnosed.

Takayasu arteritis presenting as renovascular hypertension with hypertensive encephalopathy

Takayasu arteritis is a large vessel vasculitis that has variable presentation. It is suspected when there are pulse and BP discrepancies between upper limbs or absent pulses. We here presenting a case of takayasu arteritis that remained undiagnosed till 40 years and at first time manifested with hypertensive encephalopathy and managed well with medical therapy.Journal of Advances in Internal Medicine 2017;06(02):35-37.

Effects of David I operation in the treatment of aortic root disease combined with aortic insufficiency.

We compared the effects of the new David I operation and classical Bentall operation in the treatment of aortic root disease combined with aortic insufficiency. A total of 60 cases of patients with aortic root disease combined with aortic insufficiency diagnosed at our hospital from January 2010 to January 2016 were analyzed retrospectively, including 32 cases of aortic root aneurysm, 18 cases of aortic dissection, 5 cases of hypertension combined with atherosclerosis, 2 cases of retrogression, 2 cases of rheumatic heart disease and 1 case of Takayasu arteritis. Twenty-four cases that underwent the David I operation and 36 cases that underwent the Bentall operation were selected and their therapeutic effects were compared. The operation success rate, operation time, cardiopulmonary bypass time, cross-clamp time and blood infusion of both groups were compared; there were no significant differences (P>0.05). Two patients in the David I group and 3 patients in the Bentall operation group died of multiple organ dysfunction. The LVEDd and LVEF of both groups postoperation had no difference when compared with those parameters of before operation. The diameter of the valve annulus after the operation was shorter than before the operation. The severity of valve regurgitation of both groups had no difference. However, the ratio of severe regurgitation of the David I group increased and the mild regurgitation decreased. The incidence rate of complications of the David I group was significantly lower than that of the Bentall operation group. The differences were statistically significant (P<0.05). Both David I operation and Bentall operation have better short-term and long-term effects in the treatment of aortic root disease when combined with aortic insufficiency; however, David I operation had less long-term complications.

バイパス（外腸骨～腋窩）閉塞26年後に吻合部動脈瘤を生じた高安動脈炎の1例

バイパス（外腸骨～腋窩）閉塞26年後に吻合部動脈瘤を生じた高安動脈炎の1例