P088 Prolonged fever in a boy revealing Takayasu disease: a case report

Background Takayasu's arteritis (TA) is a chronic inflammatory vasculitis of unknown origin. It affects the large vessels, especially the aorta, its main branches, and the pulmonary arteries. It begins acutely in children with severe general manifestations. The diagnosis of TA remains a challenge to clinicians due to many reasons such as its rarity, its great clinical polymorphism, and the lack of specific biological criteria. Case report A 13-years old boy with no pathological history, was admitted for prolonged fever with intermittent abdominal pain. The clinical examination has found a conscious boy, febrile with a BP of 130/90mmhg, a normal heart rate, and stable respiratory function. The cardiovascular examination noted a decrease in pedal pulses, without signs of ischaemia or necrosis, and the cardiac auscultation was normal. Examination of the lymph node areas has shown upper and left later cervical adenopathy measuring 1.7 cm in long axis, mobile, and painless. All joints were free. The complementary biological workups revealed an inflammatory syndrome (ESR: 120 mm, fibrinogen: 5 g/l, microcytic hypochromic anaemia at 9 g/dl, ferritin: 1051, low serum iron: 11µg/dl and thrombocytosis: 692 000 elements/l). Chest X-ray showed a dilated aortic button. A thoracic angioscan revealed a peri-aortitis more evident at the level of the emergence of the mesenteric artery with a pseudo-aneurysmal aspect and arteritis of the right primary carotid artery. Echocardiography was performed and showed a dilated aspect of the aorta with irregular wall. Renal ultrasound was normal. The diagnosis of Takayasu disease was made on the basis of clinical biological and essentially radiological arguments according to the diagnostic criteria of the American College of Rheumatology. The patient was treated with corticosteroid (prednisone: 2 mg/kg/d) for one month then then gradually reduced doses The disease course was marked by several relapses and the patient was then treated with mycophenolate mofetil (cellcept). Conclusion Takaysu's disease is a chronic inflammatory vasculitis of unknown origin, which affects the large- vessels, mainly the aorta, its main branches, and the pulmonary arteries; but it remains rare in children and its treatment is not well codified.

MANAGEMENT OF ANESTHESIA ON PATIENTS WHO WALK IN SESAROUS SECTION WITH ARTERITICAL TAKAYASU DISEASE

Takayasu Arteritis Disease (TA) is a chronic inflammatory, progressive, and idiopathic disease causes narrowing, obstruction and aneurysms in systemic arterial and pulmonary artery, which mainly attacks the aorta and its branches. During pregnancy, these patients should be given special attention, in connection with any complications that may occur. Case is a woman 32 years 38 weeks pregnant with TA disease with changes in several branches of the aorta since thirteen years ago. During pregnancy there are no complaints, and now she went to the hospital with 37-38 weeks gestation. Caesarean section has been done with regional anesthesia - epidural. Local anesthesia is administered by titration with the hope of sensory blockade obtained gradually. After procedure patient had observation in the recovery room and hemodynamic was stable then moved to ward. Conclusion of the case is some complications can affect pregnancy in patients with TA. In pre anesthetic evaluation should be done carefully, treatment of complications and anesthetic planning are essential. Maintenance of perfusion is a major concern for patients and neuraxial blocks can be used without harming the mother and fetus. In patients with complications of TA was still compensated, monitoring during the procedure the same as routinely used. Provision of continuous epidural anesthesia with titration to maintain hemodynamic stability and allows monitoring of cerebral perfusion through the levels of consciousness. To avoid hypoperfusion or postoperative complications of hypertensive patients should be monitored closely for 24 hours.