Childhood-onset Takayasu arteritis

Abstract

Purpose of reviewTakayasu arteritis is a rare chronic granulomatous large vessel vasculitis that predominantly affects the aorta and its branches. The purpose of this review is to unite the current knowledge regarding the pathophysiology, cause, and epidemiology as well as diagnosis, prognosis, and treatment of this condition in children. Recent findingsAlthough the etiopathogenesis is not fully understood, studies suggest an autoimmune basis for the disease as well as a genetic predisposition. It is a disease primarily affecting young women with up to a third of cases with onset in childhood. There are distinct features of childhood-onset Takayasu arteritis (cTA) that merit this separate review. Diagnostic criteria and clinical manifestations are unique in pediatric patients with renovascular hypertension being the most prevalent presentation. Traditional treatments involving highdose corticosteroids and cytotoxic agents are being reconsidered for less toxic contemporary biologic agents. Current algorithms for treatment include early introduction of corticosteroid-sparing agents, such as methotrexate or mycophenolate as well as tumor necrosis factor-alpha (TNF-a) inhibitor (infliximab, adalimumab) and/or interleukin-6 (IL-6) receptor inhibitor (tocilizumab). SummaryEarly diagnosis of cTA with goals to develop effective and well tolerated treatment paradigms are essential to improve the long-term prognosis of this rare and devastating disease.

Posterior Reversible Encephalopathy Syndrome in a Child With Renovascular Hypertension

“…The correct diagnosis is Takayasu arteritis. Takayasu arteritis is a chronic granulomatous vasculitis that affects the tunica media of medium/large arteries and produces narrowing, stenosis, and aneurysmal dilatation of aorta and its branches . In this patient, narrowing of whole length of the renal artery from its origin, involvement of ostia, and thickening of the wall of aorta favored the diagnosis of Takayasu arteritis.…”

“…The markers of inflammation-like raised C-reactive protein, erythrocyte sedimentation rate, fibrinogen, β-2-microglobulin, haptoglobin, and orosomucoid are elevated. However, there are not diagnostic of Takayasu arteritis . Takayasu arteritis should be suspected in any child that presents with hypertension or its complications.…”

“…Early systemic manifestations are usually missed in children. Headache, cardiomyopathy, kidney failure, and systolic hypertension are significantly more common in children compared with adults . The markers of inflammation-like raised C-reactive protein, erythrocyte sedimentation rate, fibrinogen, β-2-microglobulin, haptoglobin, and orosomucoid are elevated.…”

“…However, there are not diagnostic of Takayasu arteritis. 1 Takayasu arteritis should be suspected in any child that presents with hypertension or its complications. Diagnosis is usually based on presence of hypertension, pulse deficit or claudication, blood pressure discrepancies in limbs, bruits, and angiographic abnormalities.…”

Tuberculosis and Takayasu arteritis: a case report

“…Although the exact incidence of TAK in childhood has not been exactly determined until now, it seems to be a rare disease due partly to the lack of awareness of primary care physicians and the huge variety of its clinical presentations [ 8 ]. Our patient is the second case of TAK diagnosed in our department [ 9 ] and among only a few cases of TAK published worldwide affecting young infants and adolescents [ 10 ].…”