54-year-old woman with aortic dissection and paraparesis due to aortitis Текст научной статьи по специальности «Клиническая медицина»

mediterranean journal

of RHEUMATOLOGY

EAAHNIKH PEYMATQAOriA

27 1

2016

© Thomas K, Androulakis A, Koutsianas C, Anagnostopoulos C, Triantafyllou G, Kallikazaros I, Vassilopoulos D.

This work is licensed /T\ /7\

under a Creative Commons /qqA r^J Attribution-Noncommercial 4.0 International L

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54-year-old woman with aortic dissection and paraparesis due to aortitis

Konstantinos Thomas1, Aris Androulakis2, Christos Koutsianas1, Constantinos Anagnostopoulos3, Georgios Triantafyllou2, loannis Kallikazaros2, Dimitrios Vassilopoulos1

1Athens University School of Medicine, 2nd Department of Medicine and Laboratory, 2Cardiology Department, Hippokration General Hospital, ^Biomedical Research Foundation, Academy of Athens, Athens, Greece

A 54-year-old previously asymptomatic woman was presented with acute onset of chest pain and bilateral lower limb weakness. She denied any fever, headache, jaw claudication, visual defects or scalp tenderness. On clinical examination, she had low grade fever, palpable peripheral pulses and bilateral lower extremity weakness (muscle strength: 2/5) with preserved tendon reflexes and sensation. Laboratory work-up showed elevated CRP (110 mg/L, normal < 5 mg/L) and ESR (140 mm/h), nor-

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E-mai|: dvassi|op@med.uoa.gr aortic dissection extend-

Corresponding author: xj.ii

Dimitrios Vassilopoulos, md ing from the descending

Associate professor of Medicine - thoracic aorta after the

Rheumatology . .

Clinical Immunology-Rheumatology left subclavian artery to

Unit the celiac axis (type B).

2nd Department of Medicine and . .....

Laboratory Thoracic and abdominal

University of Athens Medical Schoo| aortic MRA confirmed the

Hippokration General Hospital .. ,. . . .

114 Vass. Sophias Ave. dissection and revealed

115 27 Athens aortic wall thickening,

Greece

?L +30-213-2088,5,16 Mediterr J Rheumatol 2016;27(1):29-30 Fax: +30-213-2088399

e-mail: dvassilop@med.uoa.gr https://doi.org/10.31138/mjn27.129

while a PET-CT scan showed increased aortic wall uptake of 18FDG in the areas of dissection as well as at the aortic root and ascending aorta, consistent with aortitis. Temporal artery biopsy and serum IgG4 levels were normal. The patient was diagnosed with aortitis and anterior spinal syndrome due to presumed occlusion of the Adamckiewitz artery, leading to her neurological impairment. She was initially treated with IV methylprednis-olone pulses followed by daily oral corticosteroids that resulted in rapid clinical improvement and normalization of acute phase reactants. Six months later, she was fully ambulatory without any assistance. There is an increasing number of reports in the recent literature of typical and atypical cases of non-infectious inflammatory aortitis as a cause of aortic aneurysm formation1 and dissection.2 Aortic wall inflammation can be isolated or found in systemic diseases that involve large vessels (giant-cell arteritis, Takayasu arteritis or IgG4-RD). A dissecting thoracic aneurysm in relatively young patients, with atypical features such as in this case, should raise the suspicion of aortitis that could be proven with appropriate imaging and treated appropriately. In that respect, the appropriate use of modern imaging modalities such as PET-CT scan which are very sensitive in identifying vascular inflammation represents an extremely useful tool in early diagnosis and initiation of treatment in these patients.

Ae^eiq-KAeiSiä: AYYeimöa, IgG4-öxeTiZöpevn vöooq, AneiKÖvion. Keywords: Vasculitis, IgG4-related disease, Imaging.

Cite this article as: Thomas K, Androulakis A, Koutsianas C, Anagnostopoulos C, Triantafyllou G, Kallikazaros I, Vassilopoulos D. 54-year-old woman with aortic dissection and paraparesis due to aortitis. Mediterr J Rheumatol 2016;27(1):29-30.

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27 1

2016

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CONFLICT OF INTEREST

The authors declare no conflict of interest.

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Ryder H F, Tafe L J, Burns C M. Fatal aortic dissection due to a fulminant variety of isolated aortitis. J Clin Rheumatol 2009;15:295-9.