Takayasu arteritis presenting as a recurrent respiratory tract infection: a diagnosis facilitated by bedside echocardiography and increased erythrocyte sedimentation rate.
Takayasu arteritis is a rare autoimmune disease affecting large and moderate sized arteries, often involving the aorta or coronary vasculature. We report a case of an adolescent male with a history of recurrent respiratory tract infections who presented with fever, cough, and shortness of breath and who was diagnosed with acute aortic valve failure and coronary ischemia. Ultimately, the patient's condition was attributed to Takayasa arteritis. This typical presentation of an atypical disease provides valuable teaching points, including the use of bedside echocardiography for the diagnosis of acute aortic insufficiency and the differential diagnosis of increased erythrocyte sedimentation rate. It also serves to remind clinicians to maintain a high index of suspicion for unusual disease processes in patients who fail to respond to empiric therapy for recurrent subacute illnesses.
Gerhardt
Robert T
RT
Department of Emergency Medicine, Brooke Army Medical Center/San Antonio Uniformed Services, Health Education Consortium, San Antonio, TX, USA.
De Lorenzo
Robert A
RA
D000293:Adolescent; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001706:Biopsy / Q000379:methods; D001799:Blood Sedimentation; D001026:Coronary Artery Bypass / Q000379:methods; D006801:Humans; D008297:Male; D008887:Military Medicine; D012141:Respiratory Tract Infections / Q000000981:diagnostic imaging / Q000209:etiology*; D013625:Takayasu Arteritis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography