Injury of great vessels in

our case
Ainhoa Castiella Aranzasti

Index

Vasculitis

Takayasu Arteritis

Overview of our case

Vasculitis

Inflammation of the vessels

Local symptoms depend on specific tissue damage

General symptoms fever, myalgia, arthralgia, malaise

Vasculitis - Classification

Infectious or non-infectious.

Size of the vessel affected.

Large vessel v.

Medium vessel v.

Small vessel v.

Type of HS.

HS II: ANCA

HS III: Immunecomplex

HS IV: CD4, CD8, macrophages (granulomas)

Organ specificity.

Population.

Takayasu Arteritis

Overview of our case

Personal history:

21 yo woman.

Tonsillectomy and septoplasty in 2001. Smokes 4-5 cigs. per day. Social alcohol consumption.
No known drug allergies.

Reasons for coming to consultation:

Fever: Up to 39,5C for the last 20d.

Lumbosacral pain for 30d. Dull, intense, worsens with movement, improves with
analgesics for 3-4h, but then pain and fever come back. It irradiates to anterior part of
the abdomen, but not to the lower limbs.

Left shoulder and arm pain for 2-3d, with transient loss of strength for several minutes.

Asthenia, anorexia.

In the last year, 2 episodes of loss of conscience with abnormal movements, sphincter
relaxation and post-episode confusion of 5-10mins epilepsy. When being a child,
vasovagal syncopes?

Overview of our case

Physical exam:

No cough, phlegms, throat pain nor urinary discomfort.

No nausea, vomits or diarrhea.

T: 37,7C.

HR: 120bpm (tachycardia). AP: 110/60 mmHg (normal).

Cardiac auscultation: Mid-systolic murmur I/IV in the mitral area.

Epigastric murmur.

Pulmonary auscultation: Normal breath sounds. Abdomen: Normal.

Small (<1cm) adenopathies in both jugular chains. Mobile axillar adenopathies. Can be normal.

Thyroid nodule. Can be normal, but must be observed.

Limbs: No edema.

Sacroiliac joint maneuvers are negative.

Overview of our case

Laboratory tests:

Chest Xray: Normal. MRI: Small disk herniation L4-L5, no active sacroilitis,
sacrospondyloarthropathy with dubious inflammatory activity.

Urinalysis: Normal.

Leukocytes: 7.100 with normal formula. Platelets: 381. Glucose, urea, creatinine, ions, ASAT,
ALAT, GGTP, AF, lipid profile, ferritin, TSH: normal.

Rose Bengal test, toxoplasma, salmonella, coxiella burnetti, legionella, m.pneumoniae,

chlamydia, EBV and HIV serologies, mantoux: negative. Immunoglobulins, complement, C3, C4,
ANA, ENA, ANCA, beta2microglobulin and ACE: normal. CMV IgG and IgM positive.

Hb: 11.1 anemia.

CRP: 19.3. High.

ESR: 1st hour 72. 2nd hour 78.

Ecocardiography: Mitral prolapse.

PET: FDG18 increase in glycolytic metabolism in both carotid arteries,

brachiocephalic trunk and in the aortic walls in the ascending portion, aortic arc,
thoracic descending portion, walls of pulmonary trunk INFLAMMATORY PROCESS.