Bahal Mridu, Kumar Gaurav, Mane Shailaja, Chavan Sanjay, Gupta Aryan
Pediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.
Cureus. 2024 Feb 8;16(2):e53885. doi: 10.7759/cureus.53885. eCollection 2024 Feb.
Takayasu arteritis is a chronic, idiopathic, inflammatory disease mainly affecting medium and large vessels with a significant rate of morbidity and mortality. The vessels most frequently affected are the aorta and its branches; branches originating from the aortic arch include right brachiocephalic trunk and its branches, left common carotid artery, left subclavian artery, coronary arteries from the ascending aorta, celiac trunk, right and left renal arteries, superior and inferior mesenteric arteries from the descending aorta, and right and left iliofemoral arteries. Local and systemic inflammation along with end organ ischemia is attributed to severe clinical manifestations associated with this condition. Although Takayasu arteritis is more commonly diagnosed in adults, this study highlights the unusual occurrence of childhood-onset Takayasu arteritis (TAK), presenting a unique set of diagnostic challenges. We present a case of a seven-year-old female patient who manifested atypical symptoms, such as absent pulses and malignant hypertension at an early age, leading to a delayed diagnosis. The patient's clinical course, including diagnostic workup and imaging studies such as CT or MR angiography, is thoroughly discussed. This study emphasizes the importance of recognizing the subtleties of Takayasu arteritis in children. The disease may initially masquerade as other common conditions, such as peripheral arterial disease, coarctation of aorta, renal artery stenosis, chronic renal disease, and increased intracranial pressure, thereby hindering timely diagnosis and appropriate intervention. This case underscores the importance of considering Takayasu arteritis as a differential diagnosis in children, presenting with unexplained constitutional symptoms or signs of systemic vasculitis, emphasizing the need for multidisciplinary collaboration and tailored therapeutic intervention to optimize the outcome in this rare and potentially debilitating condition.
高安动脉炎是一种慢性、特发性炎症性疾病,主要影响中、大动脉,发病率和死亡率较高。最常受累的血管是主动脉及其分支;起源于主动脉弓的分支包括右头臂干及其分支、左颈总动脉、左锁骨下动脉、升主动脉发出的冠状动脉、腹腔干、左右肾动脉、降主动脉发出的肠系膜上、下动脉以及左右髂股动脉。局部和全身炎症以及终末器官缺血是导致该疾病相关严重临床表现的原因。尽管高安动脉炎在成年人中更常见,但本研究强调了儿童期发病的高安动脉炎(TAK)的罕见情况,提出了一系列独特的诊断挑战。我们报告一例七岁女性患者,其在幼年时出现非典型症状,如脉搏消失和恶性高血压,导致诊断延迟。对该患者的临床过程,包括诊断检查以及CT或磁共振血管造影等影像学检查进行了全面讨论。本研究强调了认识儿童高安动脉炎细微表现的重要性。该疾病最初可能伪装成其他常见病症,如外周动脉疾病、主动脉缩窄、肾动脉狭窄、慢性肾病和颅内压升高,从而阻碍及时诊断和适当干预。该病例强调了在儿童出现无法解释的全身症状或系统性血管炎体征时,将高安动脉炎作为鉴别诊断的重要性,强调了多学科协作和量身定制的治疗干预对于优化这种罕见且可能使人衰弱的疾病治疗效果的必要性。