Takayasu arteritis associated with ulcerative colitis and optic neuritis: first case in Korea
A 38-year-old female was admitted with a 14-day history of dizziness, headache, and neck pain. She had a history of visual disturbance and was diagnosed with optic neuritis 4 years prior to admission. After 3 months, her symptoms fully resolved spontaneously. Five months later, she developed diarrhea, intermittent hematochezia, and iron deficiency anemia. Colonoscopy with biopsy led to the diagnosis of UC. Mesalazine resulted in clinical improvement.\nOn examination, she showed alert consciousness. Her body temperature was 36.7℃, and her pulse was regular at a rate of 80 per minute. However, her radial and brachial pulses were not detectable on either arm, and bruits were heard over the cervical region on the medial side of the sternocleidomastoid muscle. Her femoral artery, popliteal artery, and dorsalis pedis pulses were easily palpable. Laboratory findings were as follows: white blood cell count, 6,170/mm3; hemoglobin, 8.0 g/dL; and platelet count, 532,000/mm3. Her erythrocyte sedimentation rate (ESR) was 120 mm/hr, and her C-reactive protein (CRP) level was 45.93 mg/L. Other laboratory findings were within normal limits, including liver function, renal function, and urine analysis. Antineutrophil antibodies, anticardiolipin immunoglobulin M (IgM), anticardiolipin IgG, anti-β-2-glycoprotein1 IgG, anti-β-2-glycoprotein1 IgM, and antimyeloperoxidase (anti-MPO) antibodies were all negative; however, antiproteinase-3 antibodies were positive. Chest X-ray showed no cardiomegaly or lung lesions. Ultrasonography of the neck showed severe stenosis of both common carotid arteries and total occlusion of the left subclavian artery (). The left common carotid artery showed 90% luminal narrowing by dimension, whereas the right common carotid artery showed 78% luminal narrowing by dimension. The results of computed tomography scans and brain-neck magnetic resonance imaging showed diffuse wall thickening of the mid-descending thoracic aorta and aortic arch branches, diffuse stenosis of both common carotid arteries and the proximal right subclavian artery, and complete occlusion of the proximal left subclavian artery (). Positron emission tomography scans also showed FDG uptake along the thoracic aorta and arch branches, which was consistent with TA (). An echocardiogram showed GI-II/IV mitral valve regurgitation due to aortic root effacement.\nFor UC assessment, we performed sigmoidoscopy, which showed erythema, edema, exudates, and spontaneous bleeding of the bowel, which were consistent with UC ().\nFor treatment, we started high-dose prednisolone (1 mg/kg, 50 mg) and added 50 mg of azathioprine. After this treatment, the patient's dizziness improved, her neck pain subsided from a visual analogue scale score of 7 to 1, and her ESR decreased from 120 to 38 mm/hr. In addition, the bruits in the cervical region became weaker, which implied that the inflammation had improved with the medication.