A rare presentation of Takayasu’s arteritis- unilateral finger clubbing – case report

Abstract Background Takayasu’s arteritis (TA) is a granulomatous, large vessel vasculitis with a preponderance for young women. The inflammation results in disruption of the arterial endothelium causing stenosis, endoluminal thrombosis and aneurismal dilatation. Early disease presentation is with nonspecific general symptoms, and in such instances, the diagnosis can be missed. Unilateral clubbing is a manifestation of myriad of diseases, but is not a common sign of TA. In medical literature, only three such cases have been reported. Case presentation We present a 24-year-old female who presented with multiple constitutional symptoms such as arthralgia, malaise, poor appetite and two episodes of syncope over 3 months’ duration. On examination, unilateral finger clubbing was observed in the right hand, with very low volume radial, ulnar and brachial artery pulses on the ipsilateral side. Her blood pressure measured on the unaffected arm, was normal. Inflammatory markers were elevated and magnetic resonance angiogram (MRA) confirmed TA. Conclusion Although rare, unilateral clubbing may be a manifestation of TA. Therefore, detection of unilateral clubbing should raise a strong clinical suspicion of TA and prompt early diagnosis and initiation of treatment.

Download Full-text

Emphysematous pyelonephritis with air bubble in the inferior vena cava

African Journal of Urology ◽

10.1186/s12301-020-00081-2 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Tiffany A. Perkins ◽

Alberic Rogman ◽

Murali K. Ankem

Keyword(s):

Septic Shock ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Rare Presentation ◽

Emphysematous Pyelonephritis ◽

Case Presentation ◽

Air Bubble ◽

First Case ◽

The Right

Abstract Background Emphysematous pyelonephritis (EPN) with gas in the inferior vena cava (IVC) is a rare presentation and to our knowledge, this is the first case report in the urologic literature. Case presentation A 35-Year-old obese diabetic Hispanic female presented to the emergency room with a clinical picture of septic shock. Prompt computerized tomography scan revealed EPN with gas throughout the right renal parenchyma and extending to the right renal vein, IVC, and pulmonary artery. She died before surgical intervention Conclusion This case demonstrates that patients presenting with severe EPN have a high mortality risk and providers should acknowledge that septic shock, endogenous air emboli, or a combination of both could result in cardiovascular collapse and sudden death.

Download Full-text

Isolated Pulmonary Hydatid Cyst: A Rare Presentation in a Young Maasai Boy from Northern Tanzania

Case Reports in Surgery ◽

10.1155/2019/5024724 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Jay Lodhia ◽

Ayesiga Herman ◽

Rune Philemon ◽

Adnan Sadiq ◽

Deborah Mchaile ◽

...

Keyword(s):

Rare Presentation ◽

Case Presentation ◽

The Public ◽

Post Procedure ◽

Northern Tanzania ◽

Typical History ◽

History Of ◽

One Year ◽

The Right ◽

Pulmonary Hydatid Cyst

Introduction. Hydatidosis is a parasitic manifestation caused by Echinococcus granulosus. It is characterized by cystic lesions in the liver and lungs. Diagnosis is based on typical history and radiological measures. Case presentation. A four-year-old boy presented with a one-year history of dry cough and difficulty in breathing which was of gradual progression. Computed tomography of the chest revealed a large 11.7 cm×8.6 cm×11.0 cm cyst in the right hemithorax. The patient underwent thoracotomy and recovered well post procedure. Conclusion. This case report highlights that large hydatid cysts can be surgically removed with good outcome and the importance of realizing that the disease is a burden to the public health and is much neglected.

Download Full-text

Cardiomyopathy as One of the Less Frequent Manifestations of Takayasu’s Arteritis

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2016.43 ◽

2011 ◽

Vol 54 (4) ◽

pp. 167-169 ◽

Cited By ~ 2

Author(s):

Lucie Horáková ◽

Radek Pudil ◽

Zbyněk Hrnčíř ◽

Jaroslav Vižďa

Keyword(s):

Case Report ◽

Takayasu’S Arteritis ◽

Takayasu's Arteritis ◽

Newly Diagnosed ◽

Abdominal Sonography ◽

Pet Ct ◽

Inflammatory Processes ◽

The Right ◽

Thoracic And Abdominal ◽

Pet Ct Scan

The authors present the case of a young woman with newly diagnosed Takayasu’s arteritis. This woman, with arterial hypertension, was investigated for the unspecific symptoms at the beginning. Afterwards, the transthoracic echocardiography showed dysfunction of the left ventricle and the abdominal sonography showed a stenosis of the right renal artery. PET/CT scan showed chronic modification after inflammatory processes on the wall of the thoracic and abdominal aorta. This case report should be instructive to other clinicians and refers to the necessity to remember this rare disease in our country too.

Download Full-text

Refractory convulsive syncope in pregnancy: a rare presentation of Takayasu’s arteritis - a case report and literature review

African Health Sciences ◽

10.4314/ahs.v21i2.46 ◽

2021 ◽

Vol 21 (2) ◽

pp. 852-857

Author(s):

Gasthony Alobo ◽

Violah Nahurira ◽

Venice Omona ◽

Pontius Bayo ◽

Sam Olum

Keyword(s):

Case Report ◽

Takayasu’S Arteritis ◽

Epileptic Seizures ◽

Lower Limbs ◽

Takayasu's Arteritis ◽

Rare Presentation ◽

Diagnostic Dilemma ◽

Poor Outcomes ◽

Convulsive Syncope ◽

In Pregnancy

Background: Neurological manifestation of Takayasu’s Arteritis (TA) in pregnancy presenting as convulsive syncope is extremely rare, and poses a serious diagnostic dilemma due to other vast causes of fits in pregnancy. Objective: We aimed to present and shed more light on a case of TA with convulsive syncope in pregnancy refractory to anticonvulsants for seven weeks, and review the literature on the management of TA in pregnancy. Case presentation: A gravida 4 para 3+0 at 28 weeks of amenorrhea presented with repeated episodes of the sudden loss of consciousness, followed by a fall and jerking of the limbs. These were refractory to anticonvulsants that she had used for seven weeks. Physical examination revealed undetectable pulse and blood pressure (BP) in the upper limbs but elevated BP in the lower limbs. Further investigations confirmed TA and she improved on steroids and antihypertensives. Conclusion: This case typically describes the unexpected presentation of TA with convulsive syncope. It calls for meticu- lous clinical assessment of epileptic seizures in pregnancy to avoid a late diagnosis of TA and its potential poor outcomes. Keywords: Takayasu’s Arteritis in pregnancy; convulsive syncope; case report.

Download Full-text

Therapeutic approach to progressive Takayasu's arteritis

Vojnosanitetski pregled ◽

10.2298/vsp0606615p ◽

2006 ◽

Vol 63 (6) ◽

pp. 615-618

Author(s):

Ljiljana Petrovic-Rackov

Keyword(s):

Takayasu’S Arteritis ◽

Upper Extremities ◽

Bypass Grafting ◽

Takayasu's Arteritis ◽

Subclavian Artery Stenosis ◽

Left Hand ◽

Autoimmune Inflammation ◽

History Of ◽

The Right ◽

Immunosupressive Therapy

Background. Takayasu's arteritis (TA) is a nonspecific autoimmune inflammation manifested with systemic large vessel vasculitis which affects predominantly the aorta and its main branches. Case report. We presented a 40-year-old woman with a two-year history of the symptoms of compromised circulation in the head, the neck, the upper extremities and the right leg, followed by claudications in the left leg, numbness in the left hand and stenocardia. Aortic arch angyography revealed occlusion of the right subclavian artery stenosis of the right vertebral artery (20?30%) and the right iliac artery. Anti-inflammatory agents had no satisfactory effect and due to the discase progression first aorto-bifemoral bypass grafting, and 10 months later left carotid-axillary bypass grafting were performed which led to the restoration of circulation in the lower extremities and the left arm. Conclusion. This case suggested that a surgical therapy should be applied in the cases with progressive Takayasu's arteritis, particularly in the absence of a response to the conventional immunosupressive therapy to prevent eventual fatal complications.

Download Full-text

Takayasu’s Arteritis Diagnosed in an Adolescent Patient with Crohn’s Disease: Management of Biologicals

Life ◽

10.3390/life11101019 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1019

Author(s):

Kazuya Kishimoto ◽

Yuji Nozaki ◽

Toshiharu Sakurai ◽

Koji Kinoshita ◽

Masanori Funauchi ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Takayasu’S Arteritis ◽

Takayasu's Arteritis ◽

Arm Pain ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Right ◽

Necrosis Factor

We report a 14-year-old man with Crohn’s disease (CD) who developed right upper arm pain while being treated with the anti-tumor necrosis factor (TNF)-alpha monoclonal antibody, infliximab. There were no symptoms suggestive of active CD, but the inflammatory response was high, and a contrast-enhanced CT showed the occlusion of the right brachial artery. We diagnosed the patient as having Takayasu’s arteritis (TA) and started treatment with corticosteroids, then tapered off the steroids as the symptoms of TA resolved. Later, TA flared up, and his treatment was changed from infliximab to an anti-IL-6 receptor antibody, tocilizumab. The change to TCZ stabilized TA, but exacerbated CD. It is difficult to control both diseases at the same time, and the choice of biologics for treatment must be carefully considered.

Download Full-text

Takayasu’s arteritis in a child with prolonged fever. Differential diagnosis. Clinical case analysis

Medical Council ◽

10.21518/2079-701x-2021-11-140-147 ◽

2021 ◽

pp. 140-147

Author(s):

N. A. Chegodaeva ◽

E. B. Olkhova ◽

O. V. Zaytseva ◽

N. A. Savitskaya ◽

E. E. Lokshina ◽

...

Keyword(s):

Clinical Diagnosis ◽

Clinical Case ◽

Clinical Laboratory ◽

Takayasu’S Arteritis ◽

Celiac Trunk ◽

Takayasu's Arteritis ◽

Stunted Growth ◽

Prolonged Fever ◽

Oncological Diseases ◽

The Right

Takayasu’s arteritis is a chronic granulomatous arteritis with predominant involvement of the aorta and its main branches. It occurs both in youth and childhood, manifests between the ages of 10 and 30 years, female patients predominate. This article presents a clinical case of Takayasu’s arteritis in a child with prolonged fever. Clinical case. A 10-year-old girl E. was hospitalized with complaints of febrile fever episodes during the last two months; weakness and back pain were also noted. Observed by an endocrinologist since 2015 with a diagnosis of Stunted growth. Delayed physical development. Diffuse changes of the thyroid gland, euthyroidism. Since 2020 has been observed with the diagnosis Constitutional immaturity. A tendency toward constipation was noted. Observed by an allergist with atopic dermatitis, food and respiratory allergies were diagnosed. By the time of hospitalization, the girl had been ill for two months. During this period, four episodes of fever with scanty catarrhal manifestations were recorded. The diagnostic search went in different directions, infectious, systemic and oncological diseases were excluded. The echographic pattern was typical and highly specific for Takayasu’s arteritis. Additional examination also revealed changes in the celiac trunk in the form of narrowing of its lumen. Clinical diagnosis «Non-specific aortoarteritis, type III, acute phase, stenotic variant, grade 1–3 activity with lesions of the right and left common carotid arteries and the celiac trunk» was made as a result of clinical, laboratory and instrumental examination. This clinical observation demonstrates the difficulty in making a diagnosis due to the variety of clinical forms and the absence of specific disease markers. It takes on average a year and a half from disease debut to clinical diagnosis of the patient. However, lack of therapy over a long period can be crucial for an adverse outcome of the disease.

Download Full-text

Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature

Open Medicine ◽

10.1515/med-2020-0233 ◽

2021 ◽

Vol 16 (1) ◽

pp. 128-133

Author(s):

Tsung-Hsin Chang ◽

Jen-Shu Tseng

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Radical Nephrectomy ◽

Medical Literature ◽

Xanthogranulomatous Pyelonephritis ◽

Rare Presentation ◽

English Medical Literature ◽

History Of ◽

The Right

Abstract Case presentation In the current study, we report a 69-year-old female patient who was initially diagnosed with xanthogranulomatous pyelonephritis (XGPN) with nephrolithiasis and a peri-renal abscess. She presented to our department with right flank pain. Physical examination revealed right costovertebral angle knocking pain and computed tomography revealed dilated calyces and one staghorn stone over right kidney, with multiple abscess accumulations over the right peri-renal region. Right radical nephrectomy was performed using a transperitoneal flank approach, and pathology revealed squamous cell carcinoma (SCC) with concurrent XGPN. The patient was alive at 4 months post-operative follow-up. To the best of our knowledge, this is only the fifth case of renal SCC with concurrent XGPN reported in the English medical literature. Conclusion Renal SCC with coexisting XGPN is an extremely rare presentation and only four cases have been previously reported in the English medical literature. A positive diagnosis for this rare combination of diseases was established, based on pathological and immunohistochemical examinations after radical nephrectomy. Poor prognosis has been reported in such cases. Malignancies should be considered in patients with a long-standing history of urolithiasis.

Download Full-text