Bir ergende Takayasu arteritinin atipik presentasyonu

Yıl 2015, , 157 - 160, 28.11.2015

Kıymet Binnetoğlu Elif Karakoç Aydıner Safa Barış Ahmet Özen Ayşe Zöhre Feyyaz Baltacıoğlu Haner Direskeneli İşıl Barlan

https://doi.org/10.5472/MMJcr.2803.01

Cited By: 1

Öz

Takayasu arteriti çocuklarda nadir görülen bir hastalıktır. Klinik
bulgular özgün değildir ve tanısal bir laboratuvar test mevcut
değildir. Burada, atipik bir klinikle başvuran bir ergende Takayasu
arteriti sunulmaktadır. Onbeş yaşında kız çocuk kliniğimize 2
aydır süren kilo kaybı, ateş, halsizlik ve sırt ağrısı ile başvurdu.
Fizik muayenede büyüme gelişmesi normal olan hastada
patolojik bulguya rastlanmadı. Laboratuvar testlerinde akut faz
reaktanları yüksek bulundu. Manyetik resonans ile anjiografik
görüntülemelerde aorta duvarında düzensizlik ve daralmalar
saptandı. Sonuç olarak, çocuklarda Takayasu arteritinde nonspesifik
bulgular görülmektedir. Laboratuvar testleri tanısal
olmamakla beraber radyolojik bulgular oldukça özgündür.
Tedavide sistemik steroidler ve immusupresanlar kullanılmakta
ancak çocuklarda seyir erişkinlerden daha ağır olmaktadır

Anahtar Kelimeler

Ergen, HLAB51, Takayasu arteriti, Vaskülit

Atypical presentation of Takayasu’s arteritis in an adolescent

Öz

Takayasu`s arteritis is rarely seen in childhood. In addition,
symptoms are nonspecific and diagnostic laboratory marker is
unavailable. We hereby described an adolescent with an atypical
presentation of Takayasu`s arteritis. A 15-year-old girl was admitted
to our clinic with the symptoms of weight loss, fever, back pain, and
malaise since 2 months. Physical examination ended with normal
vital signs, centiles and no other pathological findings. Laboratory
findings showed increased acute phase reactants. Irregularities
in the aortic wall and luminal narrowing of aorta were detected
in magnetic resonance angiography. In conclusion, children with
Takayasu`s arteritis present with nonspecific symptoms. No
laboratory test is diagnostic, whereas abnormalities in large vessels
in radiology are specific for the disease. Mainstay of treatment is
systemic steroids and immunosuppressants and outcome is worse
in children than in adults.

Anahtar Kelimeler

Adolescent, HLAB51, Takayasu`s arteritis, Vasculitis

Kaynakça

• 1. Lightfoot RW Jr, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Art Rheum 1990;33:1088–93.
• 2. Leavitt RY, Fauci AS, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 1990;33:1101–7.
• 3. Jennette JC, Falk RJ, Andrassy K, et al. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 1994;37:187–92.
• 4. Brunner J, Feldman BM, Tyrrell PN, et al. Takayasu arteritis in children and adolescents. Rheumatology (Oxford). 2010;49:1806-14.
• 5. Cakar N, Yalcinkaya F, Duzova A, et al. Takayasu arteritis in children. J Rheumatol. 2008;35:913-9.
• 6. Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, et al. Paediatric Rheumatology International Trials Organisation (PRINTO). EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010;69:798-806.
• 7. Johnston SL, Lock RJ, Gompels MM. Takayasu arteritis: a review. J Clin Pathol 2002;55:481–6.
• 8. Morales E, Pineda C, Martinez-Lavin M. Takayasu’s arteritis in children. J Rheumatol 1991;18:1081–4.
• 9. Mehra NK, Jaini R, Balamurugan A, et al. Immunogenetic analysis of Takayasu arteritis in Indian patients. Int J Cardiol 1998;66:S127-32
• 10. Nascif AK, Lemos MD, Oliveira NS, Perim PC, Cordeiro AC, Quintino M. Takayasu’s arteritis in children and adolescents: report of three cases. Rev Bras Reumatol 2011;51:527-30. doi:10.1590/S0482-50042011000500012
• 11. Hoffman GS. Takayasu arteritis: lessons from the American National Institutes of Health experience. Int J Cardiol 1996;54:S99–102.
• 12. Hoffman GS, Merkel PA, Brasington RD, Lenschow DJ, Liang P. Anti-tumor necrosis factor therapy in patients with difficult to treat Takayasu arteritis. Arthritis Rheum 2004;50:2296–304.
• 13. Liang P, Tan-Ong M, Hoffman GS. Takayasu’s arteritis: vascular interventions and outcomes. J Rheumatol 2004;31:102–6.
• 14. Liang P, Hoffman GS. Advances in the medical and surgical treatment of Takayasu arteritis. Curr Opin Rheumatol 2005;17:16–24.
• 15. Hotchi M. Pathological studies on Takayasu arteritis. Heart Vessels 1992;7:S11-7.
• 16. Sahin Z, Bıcakcıgil M, Aksu K, et al. Turkish Takayasu Study Group. Takayasu’s arteritis is associated with HLA-B*52, but not with HLA-B*51, in Turkey. Arthritis Res Ther 2012;14:R27. doi: 10.1186/ar3730
• 17. Goel R, Kumar TS, Danda D, et al. Childhood-onset Takayasu arteritis -- experience from a tertiary care center in South India. J Rheumatol 2014;41:1183-9. doi: 10.3899/jrheum.131117.