Takayasu arteritis presenting with malignant hypertension; a rare manifestation of a rare disease: a case report and review of the literature

Patel, Bhupeshwari; Tiwari, Astha; Dubey, Shiv Ram Krishna; Bhatt, Girish Chandra; Tiwari, Punit; Bhan, Bhavna Dhingra

doi:10.1177/0049475516648062

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…5 Cases of malignant hypertension secondary to Takayasu arteritis have also been reported. 6,7 In our case, malignant hypertension which was triggered by the bilateral renal artery stenosis due to Takayasu arteritis caused acute kidney injury and advanced stage hypertensive retinopathy. In addition, unlike the other Takayasu arteritis cases with malignant hypertension, thrombotic microangiopathy was also detected.…”

Section: Discussionmentioning

confidence: 61%

A Case of Takayasu Arteritis with Thrombotic Microangiopathy Secondary to Malignant Hypertension Due to Bilateral Renal Artery Stenosis

Torun

Koca²,

Yalçınkaya³

et al. 2022

OARRR

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A 20 year old woman presented with right arm pain. Pulses of right upper extremity were weak, acute phase reactants were elevated and MR angiography demonstrated total occlusion of subclavian artery and right axillary artery with collaterals. The diagnosis was Takayasu arteritis and she was treated with prednisolone, azathioprine and acetylsalicylic acid. During follow up, azathioprine was switched to methotrexate. Three years later, patient presented with elevated blood pressure. CT angiography demonstrated reduced calibration of the aorta and almost total occlusion of the lumen of proximal parts of left and right renal arteries. C-reactive protein was elevated. Steroid dose was increased, methotrexate was discontinued and IV tocilizumab and antihypertensive medications were initiated. One month later, she presented to emergency department with elevated blood pressure and blurred vision in the left eye. Fundoscopic examination revealed bilateral grade 3 hypertensive retinopathy and serous detachment of retina in the left eye. Laboratory results revealed normal CRP, elevated creatinine, elevated lactate dehydrogenase, thrombocytopenia, low hemoglobin and low haptoglobin. Peripheral blood smear revealed 2-3 schistocytes in every field. She was admitted to rheumatology department with the diagnosis of thrombotic microangiopathy secondary to malignant hypertension. IV tocilizumab was administered, and methylprednisolone was maintained at a dose of 20 mg/day. Despite treatment with maximum dose of six antihypertensive medications, her blood pressure was not controlled adequately and she became hypervolemic. After undergoing ultrafiltration, balloon dilation was performed in the left renal artery, and a stent was placed there. After stent placement, creatinine and platelet count normalized, hemoglobin increased and hypertension was controlled. In this case, malignant hypertension which was triggered by bilateral renal artery stenosis due to Takayasu arteritis had caused acute kidney injury and advanced stage hypertensive retinopathy. In addition, unlike other Takayasu arteritis cases with malignant hypertension, thrombotic microangiopathy was also detected.

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Section: Discussionmentioning

confidence: 61%

A Case of Takayasu Arteritis with Thrombotic Microangiopathy Secondary to Malignant Hypertension Due to Bilateral Renal Artery Stenosis

Torun

Koca²,

Yalçınkaya³

et al. 2022

OARRR

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“…Although large vessel arteritis is generally diagnosed in patients before the age of 30, adult onset TAK is well described [ 3 , 11 – 13 ]. According to the American College of Rheumatology, three of six criteria are required for the diagnosis of TAK: onset at or before 40 years of age, 10 mmHg difference in brachial pressures, decreased pulsation in a brachial artery, subclavian or aortic bruit, narrowing/occlusions of the aorta, its primary branches or major proximal arteries in the extremities, and claudication of the extremities [ 14 – 16 ]. Although ESR and CRP were never obtained during her workup, according to these criteria the patient meets criteria for TAK.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Management of Middle Aortic Syndrome Presenting with Uncontrolled Hypertension

Glotzer

Bowser

Harad

et al. 2018

Case Reports in Vascular Medicine

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Middle Aortic Syndrome is a rare vascular disorder consisting of narrowing or stenosis of the distal thoracic or abdominal aorta. It is described in the literature in the form of case studies and case series. The authors present an unusual case of Middle Aortic Syndrome attributed to Takayasu's arteritis in a 60-year-old female who presented to the emergency department with uncontrolled hypertension. Traditional intervention involves open surgical bypass. This case study reviews the published literature on this rare syndrome and illustrates a successful alternative to open surgery through an endovascular approach.

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Systemic Vasculitis: An Important and Underestimated Cause of Malignant Hypertension

Zhu

Heizhati

et al. 2019

CVIA

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Objectives: Malignant hypertension (MHT) is defined as severe hypertension accompanied by ischemic failure of one or more organs. The aims of this study were to evaluate the current clinical and etiologic profiles of MHT. Methods: As a retrospective study, we selected all patients admitted to our center from January 2013 to December 2016. Seventy patients with MHT were included. Results: The average age of the patients was 40 years, and more than half of the patients were male (78.57%). There were 24 patients with essential hypertension, accounting for 34.29% of the patients, and 46 with secondary hypertension, accounting for 65.71% of the patients. For secondary MHT, systemic vasculitis (25.57%) was the most common cause, followed by severe obstructive sleep apnea syndrome (15.71%), primary renal parenchymal hypertension (11.43%), primary aldosteronism (7.14%), and Cushing syndrome (1.43%) and nutcracker phenomenon (1.43%). Twenty patients with systemic vasculitis were characterized by severe hypertension accompanied by damage to two or more target organs of differing severity. The levels of white blood cells, hypersensitive C-reactive protein, serum creatinine, and 24-hour urinary protein were above their normal range. Conclusion: Systemic vasculitis may be one of the main causes of MHT, and has been underestimated in the past. In future clinical work, clinicians need to pay more attention to patients with systemic vasculitis.

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Takayasu arteritis presenting with malignant hypertension; a rare manifestation of a rare disease: a case report and review of the literature

Cited by 3 publications

References 10 publications

A Case of Takayasu Arteritis with Thrombotic Microangiopathy Secondary to Malignant Hypertension Due to Bilateral Renal Artery Stenosis

A Case of Takayasu Arteritis with Thrombotic Microangiopathy Secondary to Malignant Hypertension Due to Bilateral Renal Artery Stenosis

Endovascular Management of Middle Aortic Syndrome Presenting with Uncontrolled Hypertension

Systemic Vasculitis: An Important and Underestimated Cause of Malignant Hypertension

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