Arteritis de Takayasu en un niño. Reporte de caso
Palabras clave:
Vasculitis; arteritis; takayasu; niñosResumen
Introducción: La arteritis de Takayasu es una vasculitis sistémica, de etiología autoinmune, que afecta principalmente a grandes vasos como la Aorta y sus ramas principales. Es poco frecuente en edad pediátrica, siendo la franja etaria más afectada la comprendida entre 10 y 18 años, con predominio del sexo femenino. Caso Clínico: Se presenta el caso de un varón de 13 años de edad, con astenia, síncopes en varias ocasiones, pérdida de peso, claudicación intermitente y dificultad respiratoria progresiva de 4 meses de evolución, hipotrófico, con palidez marcada, sudoración profusa, extremidades superiores frías y sin pulsos palpables; miembros inferiores tibios con pulsos palpables, en donde se constata cifras tensionales elevadas (240/70mmHg). A través de los análisis de laboratorio se constata anemia, con perfil inmunológico normal. Se confirma afectación de la aorta, carótidas y vasos renales por imágenes. Evolución satisfactoria con el tratamiento instaurado.
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1. Lock RJ, Gompels MM, Johnston SL. Takayasu arteritis: a review. J Clin Pathol. 2002;55:481-86. [ Links ]
2. Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE. Takayasu arteritis: clinical study of 107 cases. Am Heart J. 1977;93:94-103. [ Links ]
3. Ozen S, Ruperto N, Dillon MJ. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis. 2006;65:936-41. [ Links ]
4. Ruperto N, Ozen S, Pistorio A. EULAR/PRINTO/PRES criteria for Henoch- Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: ankara 2008, part I-Overall methodology and clinical characterisation. Ann Rheum Dis. 2010;69:790-97. [ Links ]
5. Ozen S, Pistorio A, Lusan SM. EULAR/PRINTO/PRES criteria for Henoch- Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: ankara 2008, part II-Final classification criteria. Ann Rheum Dis. 2010;69:798-806. [ Links ]
6. Petty RE, Cabral DA. Vasculitis and its classification. In: Petty RE, Laxer RM, Lindsley CB, Wedderburn LR. Textbook of pediatric rheumatology. 7 ed. Philadelphia: Elsevier; 2016. p. 448-51. [ Links ]
7. Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS. Takayasu arteritis. Ann Intern Med. 1994;120:919-29. [ Links ]
8. Aluquin VP, Albano SA, Chan F, Sandborg C, Pitlick PT. Magnetic resonance imaging in the diagnosis and follow up of Takayasu's arteritis in children. Ann Rheum Dis. 2002;61:526-29. [ Links ]
9. Kissin EY, Merkel PA. Diagnostic imaging in Takayasu arteritis. Curr Opin Rheumatol. 2004;16:31-37. [ Links ]
10. Umekita K, Takajo I, Miyauchi S, Tsurumura K, Ueno S, Kusumoto N, Kai Y, Kuroki M, Sasaki T, Okayama A. Fluorodeoxyglucose positron emission tomography is a useful tool to diagnose the early stage of Takayasu's arteritis and to evaluate the activity of the disease. Mod Rheumatol. 2006;16:243-47. [ Links ]
11. Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: New classification. Int J Cardiol. 1996;54(suppl):S155-63. [ Links ]
12. Morales E, Pineda C, Martínez LM. Takayasu's arteritis in childrens. J Rheumatol. 1991;18:1081-1084. [ Links ]
13. Numano F, Isohisa I, Maezawa H. HLA antigens in Takayasu disease. Am Heart J. 1979;98:53-57. [ Links ]
14. Vargas-Alarcón G, Zúñiga J, Gamboa R, Hernández-Pacheco G, Hesiquio R, Crúz D, Martínez-Baños D, Portal-Celhay C, Granados J, Reyes P. DNA sequencing of HLA-B alleles in Mexican patients with Takayasu arteritis. Int J Cardiol 2000;75:S117-22. [ Links ]
15. Salazar M, Varela A, Ramírez LA, Uribe O, Vásquez G, Egea E, Yunis EJ, Iglesias-Gamarra A. Association of HLA-DRB1*1602 and DRB1*1001 with Takayasu arteritis in Colombian mestizos as markers of Amerindian ancestry. Int J Cardiol. 2000;75:S113-16. [ Links ]
16. Watts R, Al-Taiar A, Mooney J, Scott D, Macgregor A. The epidemiology of Takayasu arteritis in the UK. Rheumatology. 2009;48:1008-11. [ Links ]
17. Soto ME, Espínola N, Flores-Suarez LF, Reyes PA. Takayasu arteritis: clinical features in 110 Mexican Mestizo patients and cardiovascular impact on survival and prognosis. Clin Exp Rheumatol. 2008;26(Suppl. 49):S9-S15. [ Links ]
18. Clemente G, Hilário MO, Len C, Silva CA, Sallum AM, Campos LM, Sacchetti S, Santos MC, Guariento Alves A, Ferriani VP, Sztajnbok F, Gasparello R, Knupp Oliveira S, Lessa M, Bica B, Cavalcanti A, Robazzi T, Bandeira M, Terreri MT. Estudo multicêntrico brasileiro de 71 pacientes com arterite de Takayasu juvenil: características clínicas e angiográficas. Rev Bras Reumatol. 2016;56(2):145-51. [ Links ]
19. Brunner J, Armstrong D, Feldman BM, Schneider R, Benseler S. Childhood stroke as the presentation of Takayasu's arteritis: diagnostic delay can cause catastrophic complications. J Rheumatol. 2008;35:1228-30. [ Links ]
20. Al AS, Fouillet-Desjonqueres M, David L, Barral X, Cochat P, Cimaz R. Takayasu arteritis in children. Pediatr Rheumatol Online J. 2008;6:17. [ Links ]
21. Cakar N, Yalcinkaya F, Duzova A, Caliskan S, Sirin A, Oner A, Baskin E, Bek K, Soylu A, Fitoz S, Bayazit AK, Bircan Z, Ozen S, Uncu N, Ekim M. Takayasu arteritis in children. J Rheumatol. 2008;35:913-19. [ Links ]
22. Hoffman GS, Ahmed AE. Surrogate markers of disease activity in patients with Takayasu arteritis: a preliminary report from The International Network for the Study of the Systemic Vasculitides (INSSYS). Int J Cardiol. 1998;66(Suppl. 1):S191-14. [ Links ]
23. Martini A. Behcet's disease and Takayasu's disease in children. Curr Opin Rheumatol. 1995;7:449-54. [ Links ]
24. Salvarani C, Cantini F, Boiardi L, Hunder GG. Laboratory investigations useful in giant cell arteritis and Takayasu's arteritis. Clin Exp Rheumatol. 2003;21:S23-28. [ Links ]
25. Maksimowicz-McKinnon K, Bhatt DL, Calabrese LH. Recent advances in vascular inflammation: C-reactive protein and other inflammatory biomarkers. Curr Opin Rheumatol. 2004;16:18-24. [ Links ]
26. Arnaud L, Kahn JE, Girszyn N, Piette AM, Bletry O. Takayasu's arteritis: an update on physiopathology. Eur J Intern Med. 2006;17:241-46. [ Links ]
27. Kasuya N, Kishi Y, Isobe M, Yoshida M, Numano F. P-selectin expression, but not GPIIb/IIIa activation, is enhanced in the inflammatory stage of Takayasu's arteritis. Circ J. 2006;70:600-604. [ Links ]
28. Park MC, Park YB, Jung SY, Lee KH, Lee SK. Anti-endothelial cell antibodies and antiphospholipid antibodies in Takayasu's arteritis: correlations of their titers and isotype distributions with disease activity. Clin Exp Rheumatol. 2006;24:S10-16. [ Links ]
29. Noris M. Pathogenesis of Takayasu's arteritis. J Nephrol. 2001;14:506-13. [ Links ]
30. Tripathy NK, Sinha N, Nityanand S. Anti-annexin V antibodies in Takayasu's arteritis: prevalence and relationship with disease activity. Clin Exp Immunol. 2003;134:360-64. [ Links ]
31. Kotter I, Henes JC, Wagner AD, Loock J, Gross WL. Does glucocorticosteroid-resistant large-vessel vasculitis (giant cell arteritis and Takayasu arteritis) exist and how can remission be achieved? A critical review of the literature. Clin Exp Rheumatol. 2012;30(Suppl 70):S114-29. [ Links ]
32. Ozen S, Duzova A, Bakkaloglu A, Bilginer Y, Cil BE, Demircin M, Davin JC, Bakkaloglu M. Takayasu arteritis in children: preliminary experience with cyclophosphamide induction and corticosteroids followed by methotrexate. J Pediatr. 2007;150:72-76. [ Links ]
33. Goel R, Danda D, Mathew J, Edwin N. Mycophenolate mofetil in Takayasu's arteritis. Clin Rheumatol. 2010;29:329-32. [ Links ]
34. Unizony S, Stone JH, Stone JR. New treatment strategies in large-vessel vasculitis. Curr Opin Rheumatol. 2013;25:3-9. [ Links ]
35. Salvarani C, Magnani L, Catanoso M, Pipitone N, Versari A, Dardani L, Pulsatelli L, Meliconi R, Boiardi L. Tocilizumab: a novel therapy for patients with large-vessel vasculitis. Rheumatology. 2012;51:151-56. [ Links ]
36. Ernst D, Greer M, Stoll M, Meyer-Olson D, Schmidt RE, Witte T. Remission achieved in refractory advanced Takayasu arteritis using rituximab. Case Rep Rheumatol. 2012;2012:406963. [ Links ]
37. Buonuomo PS, Bracaglia C, Campana A, Insalaco A, Pardeo M, Cortis E, Ugazio AG. Infliximab therapy in pediatric Takayasu's arteritis: report of two cases. Rheumatol Int. 2011;31:93-95. [ Links ]
38. Nunes G, Neves FS, Melo FM, de Castro GR, Zimmermann AF, Pereira IA.. Takayasu arteritis: anti-TNF therapy in a Brazilian setting. Rev Bras Reumatol. 2010;50:291-98. [ Links ]
39. Liang P, Tan-Ong M, Hoffman GS. Takayasu's arteritis: vascular interventions and outcomes. J Rheumatol. 2004;31:102-6. [ Links ]
40. Saadoun D, Lambert M, Mirault T, Resche-Rigon M, Koskas F, Cluzel P, Mignot C, Schoindre Y, Chiche L, Hatron PY, Emmerich J, Cacoub P. Retrospective analysis of surgery versus endovascular intervention in Takayasu arteritis: a multicenter experience. Circulation. 2012;125:813-19. [ Links ]
41. Liang P, Hoffman GS. Advances in the medical and surgical treatment of Takayasu arteritis. Curr Opin Rheumatol 2005;17:16-24. [ Links ]
2. Lupi-Herrera E, Sánchez-Torres G, Marcushamer J, Mispireta J, Horwitz S, Vela JE. Takayasu arteritis: clinical study of 107 cases. Am Heart J. 1977;93:94-103. [ Links ]
3. Ozen S, Ruperto N, Dillon MJ. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis. 2006;65:936-41. [ Links ]
4. Ruperto N, Ozen S, Pistorio A. EULAR/PRINTO/PRES criteria for Henoch- Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: ankara 2008, part I-Overall methodology and clinical characterisation. Ann Rheum Dis. 2010;69:790-97. [ Links ]
5. Ozen S, Pistorio A, Lusan SM. EULAR/PRINTO/PRES criteria for Henoch- Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: ankara 2008, part II-Final classification criteria. Ann Rheum Dis. 2010;69:798-806. [ Links ]
6. Petty RE, Cabral DA. Vasculitis and its classification. In: Petty RE, Laxer RM, Lindsley CB, Wedderburn LR. Textbook of pediatric rheumatology. 7 ed. Philadelphia: Elsevier; 2016. p. 448-51. [ Links ]
7. Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, Hoffman GS. Takayasu arteritis. Ann Intern Med. 1994;120:919-29. [ Links ]
8. Aluquin VP, Albano SA, Chan F, Sandborg C, Pitlick PT. Magnetic resonance imaging in the diagnosis and follow up of Takayasu's arteritis in children. Ann Rheum Dis. 2002;61:526-29. [ Links ]
9. Kissin EY, Merkel PA. Diagnostic imaging in Takayasu arteritis. Curr Opin Rheumatol. 2004;16:31-37. [ Links ]
10. Umekita K, Takajo I, Miyauchi S, Tsurumura K, Ueno S, Kusumoto N, Kai Y, Kuroki M, Sasaki T, Okayama A. Fluorodeoxyglucose positron emission tomography is a useful tool to diagnose the early stage of Takayasu's arteritis and to evaluate the activity of the disease. Mod Rheumatol. 2006;16:243-47. [ Links ]
11. Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: New classification. Int J Cardiol. 1996;54(suppl):S155-63. [ Links ]
12. Morales E, Pineda C, Martínez LM. Takayasu's arteritis in childrens. J Rheumatol. 1991;18:1081-1084. [ Links ]
13. Numano F, Isohisa I, Maezawa H. HLA antigens in Takayasu disease. Am Heart J. 1979;98:53-57. [ Links ]
14. Vargas-Alarcón G, Zúñiga J, Gamboa R, Hernández-Pacheco G, Hesiquio R, Crúz D, Martínez-Baños D, Portal-Celhay C, Granados J, Reyes P. DNA sequencing of HLA-B alleles in Mexican patients with Takayasu arteritis. Int J Cardiol 2000;75:S117-22. [ Links ]
15. Salazar M, Varela A, Ramírez LA, Uribe O, Vásquez G, Egea E, Yunis EJ, Iglesias-Gamarra A. Association of HLA-DRB1*1602 and DRB1*1001 with Takayasu arteritis in Colombian mestizos as markers of Amerindian ancestry. Int J Cardiol. 2000;75:S113-16. [ Links ]
16. Watts R, Al-Taiar A, Mooney J, Scott D, Macgregor A. The epidemiology of Takayasu arteritis in the UK. Rheumatology. 2009;48:1008-11. [ Links ]
17. Soto ME, Espínola N, Flores-Suarez LF, Reyes PA. Takayasu arteritis: clinical features in 110 Mexican Mestizo patients and cardiovascular impact on survival and prognosis. Clin Exp Rheumatol. 2008;26(Suppl. 49):S9-S15. [ Links ]
18. Clemente G, Hilário MO, Len C, Silva CA, Sallum AM, Campos LM, Sacchetti S, Santos MC, Guariento Alves A, Ferriani VP, Sztajnbok F, Gasparello R, Knupp Oliveira S, Lessa M, Bica B, Cavalcanti A, Robazzi T, Bandeira M, Terreri MT. Estudo multicêntrico brasileiro de 71 pacientes com arterite de Takayasu juvenil: características clínicas e angiográficas. Rev Bras Reumatol. 2016;56(2):145-51. [ Links ]
19. Brunner J, Armstrong D, Feldman BM, Schneider R, Benseler S. Childhood stroke as the presentation of Takayasu's arteritis: diagnostic delay can cause catastrophic complications. J Rheumatol. 2008;35:1228-30. [ Links ]
20. Al AS, Fouillet-Desjonqueres M, David L, Barral X, Cochat P, Cimaz R. Takayasu arteritis in children. Pediatr Rheumatol Online J. 2008;6:17. [ Links ]
21. Cakar N, Yalcinkaya F, Duzova A, Caliskan S, Sirin A, Oner A, Baskin E, Bek K, Soylu A, Fitoz S, Bayazit AK, Bircan Z, Ozen S, Uncu N, Ekim M. Takayasu arteritis in children. J Rheumatol. 2008;35:913-19. [ Links ]
22. Hoffman GS, Ahmed AE. Surrogate markers of disease activity in patients with Takayasu arteritis: a preliminary report from The International Network for the Study of the Systemic Vasculitides (INSSYS). Int J Cardiol. 1998;66(Suppl. 1):S191-14. [ Links ]
23. Martini A. Behcet's disease and Takayasu's disease in children. Curr Opin Rheumatol. 1995;7:449-54. [ Links ]
24. Salvarani C, Cantini F, Boiardi L, Hunder GG. Laboratory investigations useful in giant cell arteritis and Takayasu's arteritis. Clin Exp Rheumatol. 2003;21:S23-28. [ Links ]
25. Maksimowicz-McKinnon K, Bhatt DL, Calabrese LH. Recent advances in vascular inflammation: C-reactive protein and other inflammatory biomarkers. Curr Opin Rheumatol. 2004;16:18-24. [ Links ]
26. Arnaud L, Kahn JE, Girszyn N, Piette AM, Bletry O. Takayasu's arteritis: an update on physiopathology. Eur J Intern Med. 2006;17:241-46. [ Links ]
27. Kasuya N, Kishi Y, Isobe M, Yoshida M, Numano F. P-selectin expression, but not GPIIb/IIIa activation, is enhanced in the inflammatory stage of Takayasu's arteritis. Circ J. 2006;70:600-604. [ Links ]
28. Park MC, Park YB, Jung SY, Lee KH, Lee SK. Anti-endothelial cell antibodies and antiphospholipid antibodies in Takayasu's arteritis: correlations of their titers and isotype distributions with disease activity. Clin Exp Rheumatol. 2006;24:S10-16. [ Links ]
29. Noris M. Pathogenesis of Takayasu's arteritis. J Nephrol. 2001;14:506-13. [ Links ]
30. Tripathy NK, Sinha N, Nityanand S. Anti-annexin V antibodies in Takayasu's arteritis: prevalence and relationship with disease activity. Clin Exp Immunol. 2003;134:360-64. [ Links ]
31. Kotter I, Henes JC, Wagner AD, Loock J, Gross WL. Does glucocorticosteroid-resistant large-vessel vasculitis (giant cell arteritis and Takayasu arteritis) exist and how can remission be achieved? A critical review of the literature. Clin Exp Rheumatol. 2012;30(Suppl 70):S114-29. [ Links ]
32. Ozen S, Duzova A, Bakkaloglu A, Bilginer Y, Cil BE, Demircin M, Davin JC, Bakkaloglu M. Takayasu arteritis in children: preliminary experience with cyclophosphamide induction and corticosteroids followed by methotrexate. J Pediatr. 2007;150:72-76. [ Links ]
33. Goel R, Danda D, Mathew J, Edwin N. Mycophenolate mofetil in Takayasu's arteritis. Clin Rheumatol. 2010;29:329-32. [ Links ]
34. Unizony S, Stone JH, Stone JR. New treatment strategies in large-vessel vasculitis. Curr Opin Rheumatol. 2013;25:3-9. [ Links ]
35. Salvarani C, Magnani L, Catanoso M, Pipitone N, Versari A, Dardani L, Pulsatelli L, Meliconi R, Boiardi L. Tocilizumab: a novel therapy for patients with large-vessel vasculitis. Rheumatology. 2012;51:151-56. [ Links ]
36. Ernst D, Greer M, Stoll M, Meyer-Olson D, Schmidt RE, Witte T. Remission achieved in refractory advanced Takayasu arteritis using rituximab. Case Rep Rheumatol. 2012;2012:406963. [ Links ]
37. Buonuomo PS, Bracaglia C, Campana A, Insalaco A, Pardeo M, Cortis E, Ugazio AG. Infliximab therapy in pediatric Takayasu's arteritis: report of two cases. Rheumatol Int. 2011;31:93-95. [ Links ]
38. Nunes G, Neves FS, Melo FM, de Castro GR, Zimmermann AF, Pereira IA.. Takayasu arteritis: anti-TNF therapy in a Brazilian setting. Rev Bras Reumatol. 2010;50:291-98. [ Links ]
39. Liang P, Tan-Ong M, Hoffman GS. Takayasu's arteritis: vascular interventions and outcomes. J Rheumatol. 2004;31:102-6. [ Links ]
40. Saadoun D, Lambert M, Mirault T, Resche-Rigon M, Koskas F, Cluzel P, Mignot C, Schoindre Y, Chiche L, Hatron PY, Emmerich J, Cacoub P. Retrospective analysis of surgery versus endovascular intervention in Takayasu arteritis: a multicenter experience. Circulation. 2012;125:813-19. [ Links ]
41. Liang P, Hoffman GS. Advances in the medical and surgical treatment of Takayasu arteritis. Curr Opin Rheumatol 2005;17:16-24. [ Links ]
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2017-10-23
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Morel, Z., Marecos, G., Avila, G., Franco, M., Allo, N., Almada, N., Garcete, S., & Chamorro, L. (2017). Arteritis de Takayasu en un niño. Reporte de caso. Pediatría (Asunción), 44(1), 56-61. Recuperado a partir de https://revistaspp.org/index.php/pediatria/article/view/154
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