病例报告:厄瓜多尔高安动脉炎

Rocío Álvarez, Diana Ramírez, Patricia Villacís, G. Acosta
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摘要

Takayasu动脉炎是一种以慢性炎症为特征的全动脉炎,主要累及大血管,尤其是主动脉及其主要分支。这种病理极为罕见,在日本发病率较高,在拉丁美洲发病率较低。病例描述我们报告的病例是一名年轻的成年人,没有明显的病史,他表现出3个月的进化性剧烈头痛,最初分类为三叉神经痛和丛集性头痛。不对称脉搏和血压变化在两个上肢之间被观察到,允许几个推定诊断被考虑。在补充检查中,患者显示急性相反应物持续升高。我们的患者符合美国风湿病学会对高须动脉炎的四项诊断标准,并通过颈部、胸部和腹部的磁共振血管造影证实了诊断,观察到主动脉的整个路线受累。在治疗方面,一线治疗是大剂量类固醇。对于难以停用类固醇的患者,可采用免疫抑制剂联合治疗。在我们的病例中,选择了强的松和甲氨蝶呤联合治疗,这是一个有利的发展。结论高须动脉炎是一种少见的血管炎,早期诊断和治疗对改善预后、阻止疾病进展、提高患者的生活质量具有重要意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
REPORTE DE CASO: ARTERITIS DE TAKAYASU EN ECUADOR
Introduction Takayasu's arteritis is a panarteritis, characterized by chronic inflammation, that affects large vessels, especially the Aorta and its main branches. This pathology is extremely rare, has a higher incidence in Japan, presenting low incidence in Latin America. Case description We present the case of a young adult, with no significant medical history, who presents a 3 months of evolution intense headache initially classified as trigeminal neuralgia and cluster headache. Asymmetric pulses and variation in blood pressure between both upper extremities where observed which allowed several presumptive diagnoses to be considered. In the complementary examinations, the patient showed sustained elevation of acute phase reactants. Our patient met four diagnostic criteria of the American College of Rheumatology for Takayasu arteritis and the diagnosis was confirmed by magnetic Angio resonance of the neck, chest and abdomen, where involvement of the entire route of the aorta was observed. In context to treatment, the first-line therapy is high-dose steroids. In patients in whom the suspension of steroids is difficult, combined therapy with immunosuppressive agents is used. In the case of our patient, combined therapy with prednisone and methotrexate was chosen, which presented a favorable evolution. Conclusion Takayasu arteritis is an infrequent vasculitis, however, it is important to make an early diagnosis and treatment in order to improve the prognosis, stop the progression of the disease and improve the quality of life of patients suffering from this pathology.
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