A Bacterial Pneumopathy Fortuitously Revealing a Vasculitis of Takayasu: A Case Report - Abstract
Takayasu’s vasculitis is a rare chronic inflammatory arteritis of unknown origin affecting large arteries in young subjects. We report the observation of a 32-year-old female patient who presented for 6 months with dyspnea stage II mMRC associated with an intermittent cough bringing back yellowish sputum with heaviness of the left upper limb and carotidodynia. The clinical examination revealed a blood pressure of 110/70 mmHg in the right upper limb and an impregnable blood pressure in the left upper limb. The left radial, ulnar, humeral and axillary pulses were abolished. There was pain on palpation of the right jugulocarotid axis and auscultation of the vascular axes revealed a right carotid murmur. Biological assessment showed microcytic hypochromic anemia with elevated ferritin level of 209.8 ng/mg, elevated CRP of 81.9 mg/L, positive procalcitonin of 0.3 ng/mL, and accelerated 1st hour SV of 13 mm. Chest X-ray showed a right paracardial opacity. Chest CT scan showed a middle lobar condensation focus. Thoracic and supra-aortic angioscan showed parietal thickening of the aortic arch, ascending aorta, and left subclavian artery with aneurysmal dilatation of the left carotid bulb and initial portion of the internal carotid artery and occlusion of the left axillary artery in favor of Takayasu type IIa vasculitis. The patient received antibiotic treatment and background treatment with antiplatelet agents, Prednisolone and Methotrexate. The evolution was marked by the negativation of procalcitonin after 72 hours of antibiotic therapy and the disappearance of the middle lobar condensation focus.