背景:大动脉炎是一种罕见的血管炎,有严重的并发症,如中风,缺血性心脏病,肺动脉高压,继发性高血压,和动脉瘤。使用临床和血管造影标准实现诊断。治疗是内科和外科,但不幸的是,结果是有限的。病例介绍:一名34岁的白人女性患有缺血性卒中(2009年)。她被诊断患有Takayasu动脉炎,并接受甲氨蝶呤治疗,泼尼松龙,和抗血小板药物,临床状态略有改善。6年后(2015年)她经历了升主动脉瘤,肺动脉高压,和轻度主动脉瓣反流。手术治疗解决了升主动脉瘤和左颈动脉狭窄(2009年超声和2014年计算机断层扫描血管造影)。形态病理学发现1例典型的大动脉炎。肿瘤坏死因子抑制剂(TNF抑制剂)与甲氨蝶呤一起开处方。48岁(2023年)她患上了冠心病(心绞痛,心电图);超声心动图显示严重的肺动脉高压,血管造影显示冠状动脉正常,腹主动脉假性动脉瘤,和起源于右冠状动脉的动静脉瘘,并在肺动脉中引流。患者拒绝手术/介入治疗。她又接受了肿瘤坏死因子抑制剂,甲氨蝶呤,抗血小板药,和他汀类药物。结论:该病例报告显示严重的Takayasu动脉炎。我们的病人有多个动脉并发症,如前所述。她接受了免疫抑制治疗,针对冠心病的药物,和手术治疗。
Background: Takayasu\'s arteritis is a rare type of vasculitis with severe complications like stroke, ischemic heart disease, pulmonary hypertension, secondary hypertension, and aneurysms. Diagnosis is achieved using clinical and angiographic criteria. Treatment is medical and surgical, but unfortunately, the outcome is limited.
Case presentation: A 34-year-old Caucasian woman had an ischemic stroke (2009). She was diagnosed with Takayasu\'s arteritis and received treatment with methotrexate, prednisolone, and antiplatelet agents, with a mild improvement in clinical state. After 6 years (2015), she experienced an ascending aorta aneurysm, pulmonary hypertension, and mild aortic regurgitation. Surgical treatment solved both the ascending aorta aneurysm and left carotid artery stenosis (ultrasound in 2009 and computed tomography angiogram in 2014). Morphopathology revealed a typical
case of Takayasu\'s arteritis. Tumor necrosis factor inhibitors (TNF inhibitors) were prescribed with methotrexate. At 48 years old (2023), she developed coronary heart disease (angina, electrocardiogram); echocardiography revealed severe pulmonary hypertension, and angiography revealed normal coronary arteries, abdominal aorta pseudoaneurysm, and arterial-venous fistula originating in the right coronary artery with drainage in the medium pulmonary artery. The patient refused surgical/interventional treatment. She again received TNF inhibitors, methotrexate, antiplatelet agents, and statins. Conclusions: This
case report presented a severe form of Takayasu\'s arteritis. Our patient had multiple arterial complications, as previously mentioned. She received immunosuppressive treatment, medication targeted to coronary heart disease, and surgical therapy.