Reem Sarkis, MD
Cleveland Clinic Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Rashmitha Dachepally
Cleveland Clinic Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Samir Latifi, MD
PHYSICIAN
Cleveland Clinic Children's Hospital, United States
Disclosure information not submitted.
Hemant Agarwal, MBBS, MD
PHYSICIAN
Cleveland Clinic Children's Hospital, United States
Disclosure information not submitted.
Title: Takayasu Arteritis Presenting as Persistent Sore Throat
Introduction: Clinical signs and symptoms of Takayasu arteritis (TA) are often subacute and relate to chronic panarteritis of the aorta, and its primary branches. We report an unusual presentation of TA manifesting as persistent throat pain.
Description: A 19- year-old Caucasian male patient presented with 4 months of progressive sore throat and globus sensation without dysphagia, voice change or fever. He had received 2 courses of antibiotics without improvement followed by an ear- nose-throat evaluation that revealed mildly enlarged left tonsil, and normal vocal cords. Further work-up with CT scan of the neck followed by CT angiogram revealed 5 mm thickening of the aortic arch wall and branch arteries, fusiform aneurysm of innominate artery (20 mm), pseudo aneurysm of the left common carotid artery (30 mm) with mural thrombus, subtotal occlusion of left subclavian and vertebral arteries. His examination revealed normal blood pressure (120/80 mm Hg), weak pulses and 20 mm Hg decrease in systolic BP in left upper extremity, no carotydinia and his studies revealed elevated ESR: 48 mm/hour and CRP: 7.8 mg/dl. A tentative diagnosis of Takayasu’s arteritis was made (4 of 6 criteria of American College of Rheumatology for TA) and he was treated with infliximab, methylprednisolone, labetolol and aspirin that resulted in resolution of throat pain and reduction of inflammatory markers. At 4 months follow-up, he remains symptom free, has normal blood pressure and inflammatory marker levels and is awaiting vessel reimaging pending completion of his steroid course.
Discussion: TA commonly affects women of reproductive age and has greatest prevalence in Asia. Clinical features relate to systemic inflammatory response of variable intensity, to cardiovascular complications including hypertension and to direct consequences of arterial involvement such as end-organ ischemia, vascular bruits, aortic regurgitation or aneurysm rupture. Laboratory abnormalities are nonspecific and generally reflect an inflammatory process. Imaging of the arterial tree includingCT angiography and magnetic resonance angiography (MRA) are the best means of diagnosing TA. We conclude that investigations should be pursued for unusual symptoms as presentation of TA is often non-specific, silent, or pauci-symptomatic with no specific laboratory markers.