Remission Achieved in Refractory Advanced Takayasu Arteritis Using Rituximab
A 25-year-old patient was referred due to subclavian stenosis, identified on echocardiography. She presented with exertional dizziness and dyspnoea. Questioning revealed bilateral arm claudication. Examination demonstrated an absent right ulnar pulse and asymmetrical brachial blood pressure. Bruits...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Case Reports in Rheumatology |
| Online Access: | http://dx.doi.org/10.1155/2012/406963 |
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| author | D. Ernst M. Greer M. Stoll D. Meyer-Olson R. E. Schmidt T. Witte |
| author_facet | D. Ernst M. Greer M. Stoll D. Meyer-Olson R. E. Schmidt T. Witte |
| author_sort | D. Ernst |
| collection | DOAJ |
| description | A 25-year-old patient was referred due to subclavian stenosis, identified on echocardiography. She presented with exertional dizziness and dyspnoea. Questioning revealed bilateral arm claudication. Examination demonstrated an absent right ulnar pulse and asymmetrical brachial blood pressure. Bruits were evident over both common carotid arteries. Doppler ultrasound and MRI angiograms revealed occlusion or stenosis in multiple large arteries. Takayasu arteritis (TA) was diagnosed and induction therapy commenced: 1 mg/kg oral prednisolone and 500 mg/m2 intravenous cyclophosphamide (CYC). Attempts to reduce prednisolone below 15 mg/d proved impossible due to recurring disease activity. Adjuvant azathioprine 100 mg/d was subsequently added. Several weeks later, the patient was admitted with a left homonymous hemianopia. The culprit lesion in the right carotid artery was surgically managed and the patient discharged on azathioprine 150 mg/d and prednisolone 30 mg/d. Despite this, deteriorating exertional dyspnoea and angina pectoris were reported. Reimaging confirmed new stenosis in the right pulmonary artery. Surgical treatment proved infeasible. Given evidence of refractory disease activity on maximal standard therapy, we initiated rituximab, based on recently reported B-cell activity in TA. |
| format | Article |
| id | doaj-art-14101cb773c3436594979813fce3faa7 |
| institution | Kabale University |
| issn | 2090-6889 2090-6897 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Rheumatology |
| spelling | doaj-art-14101cb773c3436594979813fce3faa72025-02-03T05:44:03ZengWileyCase Reports in Rheumatology2090-68892090-68972012-01-01201210.1155/2012/406963406963Remission Achieved in Refractory Advanced Takayasu Arteritis Using RituximabD. Ernst0M. Greer1M. Stoll2D. Meyer-Olson3R. E. Schmidt4T. Witte5Clinic of Immunology and Rheumatology, Medical School Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyDepartment of Pneumology, Medical School Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyClinic of Immunology and Rheumatology, Medical School Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyClinic of Immunology and Rheumatology, Medical School Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyClinic of Immunology and Rheumatology, Medical School Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyClinic of Immunology and Rheumatology, Medical School Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyA 25-year-old patient was referred due to subclavian stenosis, identified on echocardiography. She presented with exertional dizziness and dyspnoea. Questioning revealed bilateral arm claudication. Examination demonstrated an absent right ulnar pulse and asymmetrical brachial blood pressure. Bruits were evident over both common carotid arteries. Doppler ultrasound and MRI angiograms revealed occlusion or stenosis in multiple large arteries. Takayasu arteritis (TA) was diagnosed and induction therapy commenced: 1 mg/kg oral prednisolone and 500 mg/m2 intravenous cyclophosphamide (CYC). Attempts to reduce prednisolone below 15 mg/d proved impossible due to recurring disease activity. Adjuvant azathioprine 100 mg/d was subsequently added. Several weeks later, the patient was admitted with a left homonymous hemianopia. The culprit lesion in the right carotid artery was surgically managed and the patient discharged on azathioprine 150 mg/d and prednisolone 30 mg/d. Despite this, deteriorating exertional dyspnoea and angina pectoris were reported. Reimaging confirmed new stenosis in the right pulmonary artery. Surgical treatment proved infeasible. Given evidence of refractory disease activity on maximal standard therapy, we initiated rituximab, based on recently reported B-cell activity in TA.http://dx.doi.org/10.1155/2012/406963 |
| spellingShingle | D. Ernst M. Greer M. Stoll D. Meyer-Olson R. E. Schmidt T. Witte Remission Achieved in Refractory Advanced Takayasu Arteritis Using Rituximab Case Reports in Rheumatology |
| title | Remission Achieved in Refractory Advanced Takayasu Arteritis Using Rituximab |
| title_full | Remission Achieved in Refractory Advanced Takayasu Arteritis Using Rituximab |
| title_fullStr | Remission Achieved in Refractory Advanced Takayasu Arteritis Using Rituximab |
| title_full_unstemmed | Remission Achieved in Refractory Advanced Takayasu Arteritis Using Rituximab |
| title_short | Remission Achieved in Refractory Advanced Takayasu Arteritis Using Rituximab |
| title_sort | remission achieved in refractory advanced takayasu arteritis using rituximab |
| url | http://dx.doi.org/10.1155/2012/406963 |
| work_keys_str_mv | AT dernst remissionachievedinrefractoryadvancedtakayasuarteritisusingrituximab AT mgreer remissionachievedinrefractoryadvancedtakayasuarteritisusingrituximab AT mstoll remissionachievedinrefractoryadvancedtakayasuarteritisusingrituximab AT dmeyerolson remissionachievedinrefractoryadvancedtakayasuarteritisusingrituximab AT reschmidt remissionachievedinrefractoryadvancedtakayasuarteritisusingrituximab AT twitte remissionachievedinrefractoryadvancedtakayasuarteritisusingrituximab |