Late Diagnosis of Takayasu Arteritis with Cardiac Involvement: Case Report

Maja Stojanović, Aleksandra Perić-Popadić, Sanvila Rašković, Jasna Bolpačić, Maja Vučković, Vesna Tomić Spirić, Mirjana Bogić

Abstract


Takayasu arteritis (TA) is an idiopathic chronic granulomatous vasculitis that affects aorta, its main branches and occasionally pulmonary arteries. It is more common in Asian persons, affecting predominantly young women. Clinical presentation is nonspecific at the beginning of the disease, while in the ischemic disease’s stage it depends on the territories affected. We present the case of a 26-year-old woman who was diagnosed as having TA. Multiple vascular abnormalities of aorta and its branches and severely reduced left ventricular function were present at the time of diagnosis. Immunosuppressive treatment consisting of prednisone and azathyoprine along with conventional heart failure therapy significantly improved her cardiac function.


Keywords


Takayasu arteritis; heart fealure; systemic vasculitis, fever of uknown origin

Full Text:

PDF

References


Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: a review. J Clin Pathol. 2002;55:481-6.

http://dx.doi.org/10.1136/jcp.55.7.481

PMid:12101189 PMCid:PMC1769710

Richards BL, March L, Gabriel SE. Epidemiology of large-vessel vasculitides. Best Pract Res Clin Rheumatol. 2010;24:871-3.

http://dx.doi.org/10.1016/j.berh.2010.10.008

PMid:21665132

Maffei S, Di Renzo M, Bova G, Auteri A, Pasqui AL. Takayasu's arteritis: a review of the literature. Intern Emerg Med. 2006; 1:105-12.

http://dx.doi.org/10.1007/BF02936534

PMid:17111782

Nazareth R, Mason JC. Takayasu arteritis: severe concequences of delayed diagnosis. QJM. 2011;104:797-800.

http://dx.doi.org/10.1093/qjmed/hcq193

PMid:20952441

Mason JC. Takayasu arteritis-advances in diagnosis and management. Nat Rev Rheumatol. 2010;6:406-15.

http://dx.doi.org/10.1038/nrrheum.2010.82

PMid:20596053

Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS. Takayasu arteritis. Ann Intern Med. 1994;120:919-29.

http://dx.doi.org/10.7326/0003-4819-120-11-199406010-00004

PMid:7909656

Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: a review. J Clin Pathol. 2002;55:481–6.

http://dx.doi.org/10.1136/jcp.55.7.481

PMid:12101189 PMCid:PMC1769710

Park MC, Lee SW, Park YB, Chung NS, Lee SK. Clinical characteristics and outcomes of Takayasu's arteritis: Analysis of 108 patients using standardized criteria for diagnosis, activity assessment, and angiographic classification. Scand J Rheumatol. 2005;34:284-92.

http://dx.doi.org/10.1080/03009740510026526

PMid:16195161

Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lie JT, Lightfoot RW Jr, et al. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum. 1990;33:1129-34.

http://dx.doi.org/10.1002/art.1780330811

PMid:1975175

Lambert M, Hatron PY, Hachulla E, Warembourg H, Devulder B. Takayasu's arteritis diagnosed at the early systemic phase: diagnosis with noninvasive investigation despite normal findings on angiography. J Rheumatol. 1998;25:376–7.

PMid:9489837

Tann OR, Tulloh RM, Hamilton MC: Takayasu's disease: a review. Cardiol young 2008;18:250–9.

http://dx.doi.org/10.1017/S1047951108002060

PMid:18325145

Hoffman GS, Ahmed AE. Surrogate markers of disease activity in patients with Takayasu arteritis. A preliminary report from The International Network for the Study of the Systemic Vasculitides (INSSYS). Int J Cardiol. 1998;66(Suppl. 1):S191–4.

http://dx.doi.org/10.1016/S0167-5273(98)00181-8

Takeda N, Takahashi T, Seko Y, Maemura K, Nakasone H, Sakamoto K, Hirata Y, Nagai R. Takayasu myocarditis mediated by cytotoxic T lymphocytes. Intern Med. 2005;44:256-60.

http://dx.doi.org/10.2169/internalmedicine.44.256

PMid:15805718

Talwar KK, Chopra P, Narula J, Shrivastava S, Singh SK, Sharma S, Saxena A, Rajani M, Bhatia ML. Myocardial involvement and its response to immunosuppressive therapy in nonspecific aortoarteritis (Takayasu's disease) a study by endomyocardial biopsy. Int J Cardiol. 1988;21:323–334.

http://dx.doi.org/10.1016/0167-5273(88)90109-X

Yang L, Zhang H, Jiang X, Zou Y, Qin F, Song L, Guan T, Wu H, Xu L, Liu Y, Zhou X, Bian J, Hui R, Zheng D. Clinical manifestations and longterm outcome for patients with Takayasu arteritis in China. J Rhumatol. 2014;41:2439-2446.

http://dx.doi.org/10.3899/jrheum.140664

PMid:25274886

Kasashima S, Zen Y, Kawashima A, Endo M, Matsumoto Y, Kasashima F, Ohtake H, Nakanuma YJ. A clinicopathologic study of immunoglobulin G4-related sclerosing disease of the thoracic aorta. Vasc Surg. 2010;52:1587-1595.

http://dx.doi.org/10.1016/j.jvs.2010.06.072

PMid:20678882

Maksimowicz-McKinnon K, Clark TM, Hoffman GS. Limitations of therapy and a guarded prognosis in an American cohort of Takayasu arteritis patients. Arthritis Rheum. 2007;56:1000–9.

http://dx.doi.org/10.1002/art.22404

PMid:17328078

Kotter I, Henes JC, Wagner AD, Loock J, Gross WL. Does glucocorticosteroid-resistant large-vessel vasculitis (giant cell arteritis and Takayasu arteritis) exist and how can remission be achieved? A critical review of the literature. Clin Exp Rheum. 2012;30:S114-129.

PMid:22640655

Clifford A, Hoffman GS. Resent advances in the medical management of Takayasu arteritis: un update on use biologic therapies. Curr Opin Rheumatol. 2014;26:7-15.

http://dx.doi.org/10.1097/BOR.0000000000000004

PMid:24225487

Isobe M. Takayasu arteritis revisited: current diagnosis and ttreatment. Int J Cardiol. 2013;168:3-10.

http://dx.doi.org/10.1016/j.ijcard.2013.01.022

PMid:23415176

Giordano JM. Surgical treatment of Takayasu's Arteritis. Int J Cardiol. 2000;75:S123-28.

http://dx.doi.org/10.1016/S0167-5273(00)00179-0

Dagna L, Salvo F, Tiraboschi M, Bozzolo EP, Franchini S, Doglioni C, et al. Pentraxin-3 as a marker of disease activity in Takayasu's arteritis. Ann Intern Med. 2011;155:425-433.

http://dx.doi.org/10.7326/0003-4819-155-7-201110040-00005

PMid:21969341

Yamashita H, Kubota K, Mimori A. Clinical value of whole-body PET/CT in patients with active rheumatic diseases. Arthritis Res Ther. 2014;16:423-35.

http://dx.doi.org/10.1186/s13075-014-0423-2

PMid:25606590 PMCid:PMC4289312

Santhosh S, Mittal BR, Gayana S, Bhattacharya A, Sharma A, Jain S. F-18FDG PET/CT in the evaluation of Takayasu arteritis: an experience from the topics. J Nucl Cardiol. 2014;21:993-1000.

http://dx.doi.org/10.1007/s12350-014-9910-8

PMid:24875577




DOI: http://dx.doi.org/10.3889/seejim.2015.20005

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 Maja Stojanović, Aleksandra Perić-Popadić, Sanvila Rašković, Jasna Bolpačić, Maja Vučković, Vesna Tomić Spirić, Mirjana Bogić

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


    


Published by: Id Design 2012/DOOEL Skopje, Republic of Macedonia