“A Bomb in the Chest”—Multiple aortic lesions in a patient with Takayasu’s arteritis

Mingwei Tang; Qian Wang

doi:10.2478/rir-2021-0017

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“A Bomb in the Chest”—Multiple aortic lesions in a patient with Takayasu’s arteritis

Mingwei Tang and Qian Wang

Published/Copyright: September 28, 2021

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From the journal Rheumatology and Immunology Research Volume 2 Issue 2

A 19-year-old female university student was admitted to our hospital, and she presented with fever and back pain for 15 months. The patient initially suffered from recurrent fever, upper back and neck pain, and intermittent claudication over her left upper extremity. On admission, she was pulseless on her left radial artery and the blood pressure was 70/45 mmHg and 95/60 mmHg over her left and right arm, respectively. She has strikingly elevated levels of erythrocyte sedimentation rate and Creactive protein. The color Doppler ultrasonography showed a dilatation of the initial segment of the left subclavian artery and occlusion of her right common carotid artery. Computed tomography angiography (CTA) revealed a cystic dilatation at the initial segment of the left subclavian artery as well as vessel wall thickening and localized stenosis at the right common carotid artery, aortic arch, and thoracic aorta lumen. Aortic dissection and vascular pseudolumen were also noted in the CTA. (Figure 1).^{[1, 2, 3]}

Figure 1

The CTA revealed a cystic dilatation (asterisk) of thoracic aorta. Vessel wall thickening (arrow head) and aortic dissection with vascular pseudolumen (arrow) were also noted in the CTA. CTA, computed tomography angiography. MIP: Maximum Intensity Projection.

The patient was diagnosed with Takayasu’s arteritis and treated with high dose of glucocorticoids and methotrexate. Her symptoms resolved soon after the treatment but recurred several times once the prednisone was tapered to <30 mg/d. Azathioprine, leflunomide, and cyclosporine were added successively as steroid-sparing agents but all failed to produce any satisfactory effect. Then, she was treated with tocilizumab intravenously and responded well, and the dose of prednisone was successfully tapered to 7.5 mg/d.

Acknowledgments

None.

Patient Informed Consent Declaration
The authors certify that they have obtained all appropriate patient consent documents. In the documents, the patient has given her consent for her images and other clinical information to be published in the journal.
Conflict of Interest
Qian Wang is an Editorial Board Member of the journal. The article was subject to the journal’s standard procedures, with peer review handled independently of this member and his research groups.
Ethical Statement
None.
Funding
None.

References

[1] Barra L, Kanji T, Malette J, et al. Imaging Modalities for the Diagnosis and Disease Activity Assessment of Takayasu’s Arteritis: A Systematic Review and Meta-Analysis. Autoimmun Rev. 2018;17(2):175–187.10.1016/j.autrev.2017.11.021Search in Google Scholar PubMed

[2] Weinrich JM, Lenz A, Adam G, et al. Radiologic Imaging in Large and Medium Vessel Vasculitis. Radiol Clin North Am. 2020;58(4):765–779.10.1016/j.rcl.2020.02.001Search in Google Scholar PubMed

[3] Bardi M, Diamantopoulos AP. EULAR Recommendations for the Use of Imaging in Large Vessel Vasculitis in Clinical Practice Summary. Radiol Med. 2019;124(10):965–972.10.1007/s11547-019-01058-0Search in Google Scholar PubMed

Received: 2021-05-31

Accepted: 2021-06-29

Published Online: 2021-09-28

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

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