Takayasu's Disease in a Patient with Ulcerative Colitis
A 35-year-old man visited our outpatient clinic in June 2010, presenting with pain and swelling of the right neck for 6 months. He was diagnosed with UC at his age of 25 years and had taken 2250 mg of mesalazine daily.\nHis chest X-ray was normal, but thyroid sonogram showed severe thickening of both carotid intima and media, and ulceration at the mid-portion of the right carotid artery (). Carotid CT angiography showed concentric wall thickening of both carotid arteries (). Echocardiogram showed no specific findings.\nLaboratory data were as follows: white blood cell count, 9550/mm3 with 67.9% neutrophils; hemoglobin, 8.73 g/dL; mean corpuscular volume, 57.2 femtolitre; mean corpuscular hemoglobin concentration 29.7%; erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were high at 69 mm/h and 107.5 mg/L, respectively. The data were suggestive of iron deficiency and chronic inflammatory disease. Thyroid functions, renal functions, electrolytes and liver functions were normal. The ankle brachial pressure index was normal (1.13 for right, 1.15 for left). The brachial-ankle pulse wave velocity showed harder arterial stiffness compared with age standard values (1479 cm/s for right, 1529 cm/s for left).\nFor further evaluation, he was admitted to our hospital in July 2010. On admission, his resting blood pressure was 110/60 and 100/60 mm Hg in the right and left upper limbs, respectively. The patient had swelling with tenderness existed in the right carotid area. He reported a claudication of the right upper extremity during use. Bruits were audible over the right carotid and left subclavian artery area. Coronary angiography showed no remarkable findings. However, arteriographic narrowing of the aortic branches was diffuse, especially in the right and left external carotid artery (). Chest CT angiography showed concentric wall thickening of the ascending thoracic aorta, aortic arch, proximal descending thoracic aorta, as well as the innominate artery, left common carotid, and both subclavian arteries (). He was diagnosed as concurrent TA and UC based on these findings and his history.\nThe patient received prednisolone (30 mg/day) and ferrous sulfate (256 mg twice a day) with mesalazine. Since then, several follow-ups were carried out during the following months and the patient's symptom included right neck swelling and improvement of pain. CRP and ESR levels declined to 24 mm/h and 14.2 mg/L, respectively. Hemoglobin levels were normalized (14.6 g/dL).\nDuring this follow-up period, immunological studies were conducted for evaluation of the patient's autoimmunity. Laboratory data showed: auto antibodies including antinuclear, anti-neutrophil cytoplasmic, anti-DNA and antiphospholipid antibodies, which are associated with other vascular diseases, but not TA were negative. Human leukocyte antigen (HLA) studies showed B51 and B52, which are usually seen in cases with coexisting UC and TA. In addition, the patients underwent a colonoscopy. There was moderate pancolitis and a polyp (7 mm) in the ascending colon (). A polypectomy was performed and a biopsy showed no dysplasia. With the patient's improved state, prednisolone was tapered down and the patient has been monitored through the outpatient clinic.