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Takayasu's Arteritis in a Patient with Sydenham's Chorea: is There an Association?

Vale TC, Maciel RO, Maia D, Beato R, Cardoso F - Tremor Other Hyperkinet Mov (N Y) (2012)

Bottom Line: Takayasu's arteritis (TA) has been associated with many conditions.At the age of 16, she developed a blood pressure discrepancy between the arms and faint pulses.The presence of rheumatic fever and Sydenham's chorea in TA raises the possibility of an immunological basis for the pathogenesis of the disease.

View Article: PubMed Central - PubMed

Affiliation: Movement Disorders Clinic, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

ABSTRACT

Background: Takayasu's arteritis (TA) has been associated with many conditions. Herein described is a case of TA in a patient with rheumatic fever complicated with Sydenham's chorea.

Case report: A 17-year-old female presented at age 6 with rheumatic fever followed by chorea a month later. At the age of 16, she developed a blood pressure discrepancy between the arms and faint pulses. Computed tomography angiography revealed diffuse aortic involvement and narrowing of the arteries.

Discussion: The presence of rheumatic fever and Sydenham's chorea in TA raises the possibility of an immunological basis for the pathogenesis of the disease.

No MeSH data available.


Related in: MedlinePlus

Computed Tomography Angiography of the Neck.(A) Bifurcation of the right common carotid artery showing area of stenosis (arrow) in the proximal external carotid artery. (B) Narrowing and contour abnormalities (arrows) in both subclavian arteries.
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f01: Computed Tomography Angiography of the Neck.(A) Bifurcation of the right common carotid artery showing area of stenosis (arrow) in the proximal external carotid artery. (B) Narrowing and contour abnormalities (arrows) in both subclavian arteries.

Mentions: At the age of 14, she developed another bout of mild choreic movements, which resolved in 3 months after a short course of haloperidol (2 mg/day). At the time, a clinical cardiologic examination was unrevealing, but echocardiography disclosed a thickened mitral valve causing mild mitral regurgitation and mild valve prolapse. At the age of 16, on a regular follow-up examination, she was found to have bilaterally faint radial and brachial pulses and a 20 mmHg discrepancy in the systolic blood pressure between the arms. Cervical ultrasonography disclosed diffuse thickened subclavian arteries. Computed tomography angiography showed diffuse aortic involvement with mild stenosis of the mesenteric, common hepatic, and right renal arteries. Both subclavian arteries and the left external carotid artery also had narrowing and contour abnormalities. In addition, there was a moderate stenosis of the proximal portion of the right external carotid artery (Figure 1). Brain magnetic resonance imaging was normal. Antinuclear antibodies, antineutrophil cytoplasmic antibodies, lupus anticoagulant, and anticardiolipin antibodies were negative. The erythrocyte sedimentation rate was 69 mm/hour (normal value <13 mm/hour). She fulfilled the 1990 American College of Rheumatology criteria for TA and was classified as having type III angiographic features according to the Takayasu Conference Classification.2, 9 She was treated with methotrexate (7.5 mg four times a week) combined with prednisone (60 mg/day).


Takayasu's Arteritis in a Patient with Sydenham's Chorea: is There an Association?

Vale TC, Maciel RO, Maia D, Beato R, Cardoso F - Tremor Other Hyperkinet Mov (N Y) (2012)

Computed Tomography Angiography of the Neck.(A) Bifurcation of the right common carotid artery showing area of stenosis (arrow) in the proximal external carotid artery. (B) Narrowing and contour abnormalities (arrows) in both subclavian arteries.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569897&req=5

f01: Computed Tomography Angiography of the Neck.(A) Bifurcation of the right common carotid artery showing area of stenosis (arrow) in the proximal external carotid artery. (B) Narrowing and contour abnormalities (arrows) in both subclavian arteries.
Mentions: At the age of 14, she developed another bout of mild choreic movements, which resolved in 3 months after a short course of haloperidol (2 mg/day). At the time, a clinical cardiologic examination was unrevealing, but echocardiography disclosed a thickened mitral valve causing mild mitral regurgitation and mild valve prolapse. At the age of 16, on a regular follow-up examination, she was found to have bilaterally faint radial and brachial pulses and a 20 mmHg discrepancy in the systolic blood pressure between the arms. Cervical ultrasonography disclosed diffuse thickened subclavian arteries. Computed tomography angiography showed diffuse aortic involvement with mild stenosis of the mesenteric, common hepatic, and right renal arteries. Both subclavian arteries and the left external carotid artery also had narrowing and contour abnormalities. In addition, there was a moderate stenosis of the proximal portion of the right external carotid artery (Figure 1). Brain magnetic resonance imaging was normal. Antinuclear antibodies, antineutrophil cytoplasmic antibodies, lupus anticoagulant, and anticardiolipin antibodies were negative. The erythrocyte sedimentation rate was 69 mm/hour (normal value <13 mm/hour). She fulfilled the 1990 American College of Rheumatology criteria for TA and was classified as having type III angiographic features according to the Takayasu Conference Classification.2, 9 She was treated with methotrexate (7.5 mg four times a week) combined with prednisone (60 mg/day).

Bottom Line: Takayasu's arteritis (TA) has been associated with many conditions.At the age of 16, she developed a blood pressure discrepancy between the arms and faint pulses.The presence of rheumatic fever and Sydenham's chorea in TA raises the possibility of an immunological basis for the pathogenesis of the disease.

View Article: PubMed Central - PubMed

Affiliation: Movement Disorders Clinic, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

ABSTRACT

Background: Takayasu's arteritis (TA) has been associated with many conditions. Herein described is a case of TA in a patient with rheumatic fever complicated with Sydenham's chorea.

Case report: A 17-year-old female presented at age 6 with rheumatic fever followed by chorea a month later. At the age of 16, she developed a blood pressure discrepancy between the arms and faint pulses. Computed tomography angiography revealed diffuse aortic involvement and narrowing of the arteries.

Discussion: The presence of rheumatic fever and Sydenham's chorea in TA raises the possibility of an immunological basis for the pathogenesis of the disease.

No MeSH data available.


Related in: MedlinePlus