Purpose or Case Report: Crohn’s disease is a common form of granulomatous inflammation affecting the gastrointestinal tract. Takayasu arteritis, a rare large-vessel vasculitis also known as pulseless disease, involves the inflammation, thickening, and narrowing of major arteries such as the aorta and its branches. There is evidence of a higher prevalence of Crohn's disease in patients with Takayasu arteritis, suggesting a potential link between these conditions. This case report highlights the presentation of Takayasu arteritis in a pediatric patient with Crohn’s disease, emphasizing the role of imaging in diagnosis.
An 8-year-old female with a history of Crohn’s colitis was referred to nephrology for hypertensive emergency workup. Her blood pressure was recorded at 158/97 mmHg, prompting an echocardiogram that revealed elevated left ventricular (LV) mass, LV dilatation, eccentric hypertrophy, abnormal diastolic function, and moderate aortic insufficiency—all consistent with hypertensive emergency. A CT angiogram of the chest and abdomen with IV contrast identified infrarenal aortic stenosis, a retroperitoneal soft tissue encasing the stenotic segment, and thickening of the right common carotid artery. These findings were further validated by a Carotid Doppler ultrasound, which showed right common carotid artery wall thickening (0.41cm) with less than 50% stenosis, indicative of vasculitis consistent with Takayasu arteritis. Additionally, MRI revealed diffuse mural thickening, enhancement, and diffusion restriction of the abdominal aorta, with extension to the mesenteric, renal arteries, and left common iliac artery, confirming active arteritis.
Laboratory results showed elevated inflammatory markers, including CRP (2.7), ESR (120), and IgG1 (1658). Normal IgG4 levels ruled out IgG4-related disease. The patient was started on amlodipine and atenolol for hypertension, along with solumedrol for vasculitis. Infliximab, azathioprine, aspirin, and Bactrim were also initiated for Crohn’s and vasculitis management.
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Conclusions: This case demonstrates the rare co-occurrence of Takayasu arteritis and Crohn’s disease in a pediatric patient, emphasizing the need for a multidisciplinary approach and thorough imaging workup. The role of echocardiography, CT angiography, Doppler ultrasound, and MRI were critical in confirming the diagnosis of Takayasu arteritis. Understanding the relationship between Crohn’s disease and Takayasu arteritis may help clinicians identify and manage similar cases in the future.