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Case report: Aggressive progression of acute heart failure due to juvenile tuberculosis-associated Takayasu arteritis with aortic stenosis and thrombosis

BACKGROUND: Takayasu arteritis (TA) is a chronic granulomatous vasculitis with unknown pathophysiology. TA with severe aortic obstruction has a poor prognosis. However, the efficacy of biologics and appropriate timing of surgical intervention remain controversial. We report a case of tuberculosis (T...

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Autores principales: Xuan, Wenjie, Wang, Zhaoling, Lin, Jinjing, Zou, Lixia, Xu, Xisheng, Yang, Xinghui, Xu, Yiping, Zhang, Yan, Zheng, Qi, Xu, Xuefeng, Lu, Meiping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10070724/
https://www.ncbi.nlm.nih.gov/pubmed/37025681
http://dx.doi.org/10.3389/fcvm.2023.1076118
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author Xuan, Wenjie
Wang, Zhaoling
Lin, Jinjing
Zou, Lixia
Xu, Xisheng
Yang, Xinghui
Xu, Yiping
Zhang, Yan
Zheng, Qi
Xu, Xuefeng
Lu, Meiping
author_facet Xuan, Wenjie
Wang, Zhaoling
Lin, Jinjing
Zou, Lixia
Xu, Xisheng
Yang, Xinghui
Xu, Yiping
Zhang, Yan
Zheng, Qi
Xu, Xuefeng
Lu, Meiping
author_sort Xuan, Wenjie
collection PubMed
description BACKGROUND: Takayasu arteritis (TA) is a chronic granulomatous vasculitis with unknown pathophysiology. TA with severe aortic obstruction has a poor prognosis. However, the efficacy of biologics and appropriate timing of surgical intervention remain controversial. We report a case of tuberculosis (TB)-associated TA with aggressive acute heart failure (AHF), pulmonary hypertension (PH), thrombosis, and seizure, who failed to survive after surgery. CASE PRESENTATION: A 10-year-old boy who developed a cough with chest tightness, shortness of breath, hemoptysis with reduced left ventricular ejection fraction, PH, and increased C-reactive protein and erythrocyte sedimentation rate was hospitalized at the pediatric intensive care unit of our hospital. He had strongly positive purified protein derivative skin test and interferon-gamma release assay result. Computed tomography angiography (CTA) showed occlusion of proximal left subclavian artery and stenosis of descending aorta and upper abdominal aorta. His condition did not improve after administration of milrinone, diuretics, antihypertensive agents, and intravenous methylprednisolone pulse followed by oral prednisone. Intravenous tocilizumab was administered for five doses, followed by two doses of infliximab, but his HF worsened, and CTA on day 77 showed complete occlusion of the descending aorta with large thrombus. He had a seizure on day 99 with deterioration of renal function. Balloon angioplasty and catheter-directed thrombolysis were performed on day 127. Unfortunately, the child's heart function continued to deteriorate and died on day 133. CONCLUSION: TB infection may be related to juvenile TA. The biologics, thrombolysis, and surgical intervention failed to achieve the anticipated effect in our case with aggressive AHF due to severe aortic stenosis and thrombosis. More studies are needed to determine the role of biologics and surgery in such dire cases.
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spelling pubmed-100707242023-04-05 Case report: Aggressive progression of acute heart failure due to juvenile tuberculosis-associated Takayasu arteritis with aortic stenosis and thrombosis Xuan, Wenjie Wang, Zhaoling Lin, Jinjing Zou, Lixia Xu, Xisheng Yang, Xinghui Xu, Yiping Zhang, Yan Zheng, Qi Xu, Xuefeng Lu, Meiping Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Takayasu arteritis (TA) is a chronic granulomatous vasculitis with unknown pathophysiology. TA with severe aortic obstruction has a poor prognosis. However, the efficacy of biologics and appropriate timing of surgical intervention remain controversial. We report a case of tuberculosis (TB)-associated TA with aggressive acute heart failure (AHF), pulmonary hypertension (PH), thrombosis, and seizure, who failed to survive after surgery. CASE PRESENTATION: A 10-year-old boy who developed a cough with chest tightness, shortness of breath, hemoptysis with reduced left ventricular ejection fraction, PH, and increased C-reactive protein and erythrocyte sedimentation rate was hospitalized at the pediatric intensive care unit of our hospital. He had strongly positive purified protein derivative skin test and interferon-gamma release assay result. Computed tomography angiography (CTA) showed occlusion of proximal left subclavian artery and stenosis of descending aorta and upper abdominal aorta. His condition did not improve after administration of milrinone, diuretics, antihypertensive agents, and intravenous methylprednisolone pulse followed by oral prednisone. Intravenous tocilizumab was administered for five doses, followed by two doses of infliximab, but his HF worsened, and CTA on day 77 showed complete occlusion of the descending aorta with large thrombus. He had a seizure on day 99 with deterioration of renal function. Balloon angioplasty and catheter-directed thrombolysis were performed on day 127. Unfortunately, the child's heart function continued to deteriorate and died on day 133. CONCLUSION: TB infection may be related to juvenile TA. The biologics, thrombolysis, and surgical intervention failed to achieve the anticipated effect in our case with aggressive AHF due to severe aortic stenosis and thrombosis. More studies are needed to determine the role of biologics and surgery in such dire cases. Frontiers Media S.A. 2023-03-21 /pmc/articles/PMC10070724/ /pubmed/37025681 http://dx.doi.org/10.3389/fcvm.2023.1076118 Text en © 2023 Xuan, Wang, Lin, Zou, Xu, Yang, Xu, Zhang, Zheng, Xu and Lu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Xuan, Wenjie
Wang, Zhaoling
Lin, Jinjing
Zou, Lixia
Xu, Xisheng
Yang, Xinghui
Xu, Yiping
Zhang, Yan
Zheng, Qi
Xu, Xuefeng
Lu, Meiping
Case report: Aggressive progression of acute heart failure due to juvenile tuberculosis-associated Takayasu arteritis with aortic stenosis and thrombosis
title Case report: Aggressive progression of acute heart failure due to juvenile tuberculosis-associated Takayasu arteritis with aortic stenosis and thrombosis
title_full Case report: Aggressive progression of acute heart failure due to juvenile tuberculosis-associated Takayasu arteritis with aortic stenosis and thrombosis
title_fullStr Case report: Aggressive progression of acute heart failure due to juvenile tuberculosis-associated Takayasu arteritis with aortic stenosis and thrombosis
title_full_unstemmed Case report: Aggressive progression of acute heart failure due to juvenile tuberculosis-associated Takayasu arteritis with aortic stenosis and thrombosis
title_short Case report: Aggressive progression of acute heart failure due to juvenile tuberculosis-associated Takayasu arteritis with aortic stenosis and thrombosis
title_sort case report: aggressive progression of acute heart failure due to juvenile tuberculosis-associated takayasu arteritis with aortic stenosis and thrombosis
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10070724/
https://www.ncbi.nlm.nih.gov/pubmed/37025681
http://dx.doi.org/10.3389/fcvm.2023.1076118
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