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Takayasu arteritis and antiphospholipid antibody syndrome in an elderly woman.

Lee HJ, Hwang JP, Kim HS - Korean J. Intern. Med. (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.

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To the Editor, Takayasu arteritis (TA) is a chronic vasculitis of unknown etiology involving primarily the aorta and its main branches... CT aortography revealed uptake by the walls of both the thoracic and abdominal aortas, suggestive of a large-vessel vasculitis such as TA... A pulmonary embolism was also accidentally found... Linear distinct FDG uptake was evident in both the subclavian and axillary arteries (maxSUV, 2.2), and the ascending aorta and aortic arch (maxSUV, 2.1), indicating vasculitis (Fig. 2)... We found no evidence of malignancy... Although she denied any symptom of dyspnea, a pulmonary embolism was found by chance... In addition, FDG-PET is also useful to evaluate the efficacy of steroid therapy... A cohort study of 28 Mexican TA patients found no antiphospholipid antibodies... However, a few reports have in fact described an association between arteritis and APS... A Japanese report noted that a high titer of antiphospholipid antibodies may trigger large-vessel involvement in secondary APS... In our case, anticoagulative and immunosuppressive drugs were prescribed to control both the TA and the APS... Steroids reduce disease activity and help to prevent any need for restenosis; anticoagulants prevent thrombotic events.

No MeSH data available.


Related in: MedlinePlus

Arteriography of both upper extremities. Severe stenosis is evident in the right subclavian and axillary arteries (A, arrow), and in the left subclavian artery, with reduced blood flow distal to the lesion (B, arrow).
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f1-kjim-30-6-934: Arteriography of both upper extremities. Severe stenosis is evident in the right subclavian and axillary arteries (A, arrow), and in the left subclavian artery, with reduced blood flow distal to the lesion (B, arrow).

Mentions: Cervical spine magnetic resonance imaging showed that both cord compression and stenosis were absent, but upper extremity angiography revealed severe stenosis of both the subclavian and axillary arteries (Fig. 1). Arteries distal to the site of stenosis, including the brachial, radial, and ulnar arteries, exhibited decreased blood flow, with the development of collateral arteries in the surrounding region. CT aortography revealed uptake by the walls of both the thoracic and abdominal aortas, suggestive of a large-vessel vasculitis such as TA. A pulmonary embolism was also accidentally found. FDG-PET/CT was performed after injection of 12.1 mCi 18F-FDG to assess the vasculitis. Linear distinct FDG uptake was evident in both the subclavian and axillary arteries (maxSUV, 2.2), and the ascending aorta and aortic arch (maxSUV, 2.1), indicating vasculitis (Fig. 2). We found no evidence of malignancy. Although she denied any symptom of dyspnea, a pulmonary embolism was found by chance. CT revealed multiple embolisms of both pulmonary arteries (Fig. 3). The anti-cardiolipin antibody immunoglobulin M (IgM) titer was 14.10 IgM phospholipid (MPL) units (normal range, < 7.0). The anti-β2 glycoprotein-1 antibody IgM titer was 22.0 U/mL (normal range, < 5), and the anti-lupus anticoagulant antibody titer was 1.91 (normal range, 0 to 1.24). The level of protein S was 54.5% (normal range, 50.8 to 116.9), the level of protein C was 173% (normal range, 70 to 148), and the level of antithrombin III was 120% (normal range, 65 to 129). On follow-up blood tests run 12 weeks later, she was positive for anti-cardiolipin antibody IgM, at 11.80 MPL units (normal range, < 7.0).


Takayasu arteritis and antiphospholipid antibody syndrome in an elderly woman.

Lee HJ, Hwang JP, Kim HS - Korean J. Intern. Med. (2015)

Arteriography of both upper extremities. Severe stenosis is evident in the right subclavian and axillary arteries (A, arrow), and in the left subclavian artery, with reduced blood flow distal to the lesion (B, arrow).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4642027&req=5

f1-kjim-30-6-934: Arteriography of both upper extremities. Severe stenosis is evident in the right subclavian and axillary arteries (A, arrow), and in the left subclavian artery, with reduced blood flow distal to the lesion (B, arrow).
Mentions: Cervical spine magnetic resonance imaging showed that both cord compression and stenosis were absent, but upper extremity angiography revealed severe stenosis of both the subclavian and axillary arteries (Fig. 1). Arteries distal to the site of stenosis, including the brachial, radial, and ulnar arteries, exhibited decreased blood flow, with the development of collateral arteries in the surrounding region. CT aortography revealed uptake by the walls of both the thoracic and abdominal aortas, suggestive of a large-vessel vasculitis such as TA. A pulmonary embolism was also accidentally found. FDG-PET/CT was performed after injection of 12.1 mCi 18F-FDG to assess the vasculitis. Linear distinct FDG uptake was evident in both the subclavian and axillary arteries (maxSUV, 2.2), and the ascending aorta and aortic arch (maxSUV, 2.1), indicating vasculitis (Fig. 2). We found no evidence of malignancy. Although she denied any symptom of dyspnea, a pulmonary embolism was found by chance. CT revealed multiple embolisms of both pulmonary arteries (Fig. 3). The anti-cardiolipin antibody immunoglobulin M (IgM) titer was 14.10 IgM phospholipid (MPL) units (normal range, < 7.0). The anti-β2 glycoprotein-1 antibody IgM titer was 22.0 U/mL (normal range, < 5), and the anti-lupus anticoagulant antibody titer was 1.91 (normal range, 0 to 1.24). The level of protein S was 54.5% (normal range, 50.8 to 116.9), the level of protein C was 173% (normal range, 70 to 148), and the level of antithrombin III was 120% (normal range, 65 to 129). On follow-up blood tests run 12 weeks later, she was positive for anti-cardiolipin antibody IgM, at 11.80 MPL units (normal range, < 7.0).

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

To the Editor, Takayasu arteritis (TA) is a chronic vasculitis of unknown etiology involving primarily the aorta and its main branches... CT aortography revealed uptake by the walls of both the thoracic and abdominal aortas, suggestive of a large-vessel vasculitis such as TA... A pulmonary embolism was also accidentally found... Linear distinct FDG uptake was evident in both the subclavian and axillary arteries (maxSUV, 2.2), and the ascending aorta and aortic arch (maxSUV, 2.1), indicating vasculitis (Fig. 2)... We found no evidence of malignancy... Although she denied any symptom of dyspnea, a pulmonary embolism was found by chance... In addition, FDG-PET is also useful to evaluate the efficacy of steroid therapy... A cohort study of 28 Mexican TA patients found no antiphospholipid antibodies... However, a few reports have in fact described an association between arteritis and APS... A Japanese report noted that a high titer of antiphospholipid antibodies may trigger large-vessel involvement in secondary APS... In our case, anticoagulative and immunosuppressive drugs were prescribed to control both the TA and the APS... Steroids reduce disease activity and help to prevent any need for restenosis; anticoagulants prevent thrombotic events.

No MeSH data available.


Related in: MedlinePlus