PDF(Pubmed)
Abstract：
UNASSIGNED: Takayasu arteritis is a large-vessel vasculitis that affects the aorta and its primary branches. Myocarditis is a rare life-threatening complication and potential diagnostic pitfall in patients with Takayasu arteritis.
UNASSIGNED: A previously healthy 18-year-old woman presenting with fever, back pain, and dyspnoea was admitted to another hospital for acute hypertension (blood pressure, 230/106 mmHg) and congestive heart failure. Intravenous methylprednisolone pulse with antihypertensive and diuretic medications slightly improved her congestion. However, she developed acute kidney injury and was transferred to our hospital. Transthoracic echocardiography indicated a left ventricular ejection fraction of 45% and diffuse left ventricular hypokinesis. Doppler ultrasound test and magnetic resonance angiography revealed severe bilateral renal artery stenosis. Her diagnosis was Takayasu arteritis, and she received high-dose glucocorticoids. She required temporary haemodialysis, but 2 months after admission, her serum creatinine improved to 1.1 mg/dL without surgical or cardiovascular interventions. Although the pre-discharge test with 1.5 T cardiac magnetic resonance initially failed to diagnose myocarditis, 3 T cardiac magnetic resonance imaging revealed increased native T1 values on T1 mapping (1283-1393 ms), moderate pericardial effusion, and systolic left ventricular wall motion abnormality, indicating active myocarditis. During 6-month subcutaneous tocilizumab treatment (162 mg/week), a left ventricular ejection fraction improved to 55-60% without a relapse.
UNASSIGNED: This case report highlights the benefits of early multimodal imaging tests including cardiac magnetic resonance imaging for myocarditis and renal artery involvement in Takayasu arteritis. Tocilizumab might be an efficient therapeutic option for severe acute manifestations including myocarditis in young women of reproductive age.
UNASSIGNED: A previously healthy 18-year-old woman presenting with fever, back pain, and dyspnoea was admitted to another hospital for acute hypertension (blood pressure, 230/106 mmHg) and congestive heart failure. Intravenous methylprednisolone pulse with antihypertensive and diuretic medications slightly improved her congestion. However, she developed acute kidney injury and was transferred to our hospital. Transthoracic echocardiography indicated a left ventricular ejection fraction of 45% and diffuse left ventricular hypokinesis. Doppler ultrasound test and magnetic resonance angiography revealed severe bilateral renal artery stenosis. Her diagnosis was Takayasu arteritis, and she received high-dose glucocorticoids. She required temporary haemodialysis, but 2 months after admission, her serum creatinine improved to 1.1 mg/dL without surgical or cardiovascular interventions. Although the pre-discharge test with 1.5 T cardiac magnetic resonance initially failed to diagnose myocarditis, 3 T cardiac magnetic resonance imaging revealed increased native T1 values on T1 mapping (1283-1393 ms), moderate pericardial effusion, and systolic left ventricular wall motion abnormality, indicating active myocarditis. During 6-month subcutaneous tocilizumab treatment (162 mg/week), a left ventricular ejection fraction improved to 55-60% without a relapse.
UNASSIGNED: This case report highlights the benefits of early multimodal imaging tests including cardiac magnetic resonance imaging for myocarditis and renal artery involvement in Takayasu arteritis. Tocilizumab might be an efficient therapeutic option for severe acute manifestations including myocarditis in young women of reproductive age.
摘要：
■大动脉炎是一种影响主动脉及其主要分支的大血管血管炎。心肌炎是Takayasu动脉炎患者中罕见的危及生命的并发症和潜在的诊断陷阱。
■一位以前健康的18岁女性发烧，背痛,呼吸困难因急性高血压(血压，230/106mmHg）和充血性心力衰竭。静脉注射甲基强的松龙脉冲与抗高血压和利尿剂药物轻微改善她的充血。然而,她出现了急性肾损伤，并被转移到我们医院。经胸超声心动图显示左心室射血分数为45％，弥漫性左心室运动障碍。多普勒超声检查和磁共振血管造影显示双侧肾动脉严重狭窄。她的诊断是大动脉炎,她接受了高剂量的糖皮质激素.她需要临时血液透析,但入院后2个月,在没有手术或心血管干预的情况下,她的血清肌酐改善至1.1mg/dL.尽管最初使用1.5T心脏磁共振进行的出院前测试未能诊断心肌炎，3T心脏磁共振成像显示T1标测上的天然T1值增加（1283-1393ms），中度心包积液,收缩期左心室壁运动异常,提示活动性心肌炎.在6个月的皮下托珠单抗治疗（162毫克/周），左心室射血分数改善至55-60%,无复发.
■本病例报告重点介绍了早期多模态影像学检查，包括心脏磁共振成像对心肌炎和肾大动脉炎累及的益处。Tocilizumab可能是育龄年轻女性严重急性表现包括心肌炎的有效治疗选择。
■一位以前健康的18岁女性发烧，背痛,呼吸困难因急性高血压(血压，230/106mmHg）和充血性心力衰竭。静脉注射甲基强的松龙脉冲与抗高血压和利尿剂药物轻微改善她的充血。然而,她出现了急性肾损伤，并被转移到我们医院。经胸超声心动图显示左心室射血分数为45％，弥漫性左心室运动障碍。多普勒超声检查和磁共振血管造影显示双侧肾动脉严重狭窄。她的诊断是大动脉炎,她接受了高剂量的糖皮质激素.她需要临时血液透析,但入院后2个月,在没有手术或心血管干预的情况下,她的血清肌酐改善至1.1mg/dL.尽管最初使用1.5T心脏磁共振进行的出院前测试未能诊断心肌炎，3T心脏磁共振成像显示T1标测上的天然T1值增加（1283-1393ms），中度心包积液,收缩期左心室壁运动异常,提示活动性心肌炎.在6个月的皮下托珠单抗治疗（162毫克/周），左心室射血分数改善至55-60%,无复发.
■本病例报告重点介绍了早期多模态影像学检查，包括心脏磁共振成像对心肌炎和肾大动脉炎累及的益处。Tocilizumab可能是育龄年轻女性严重急性表现包括心肌炎的有效治疗选择。
