Dengue Arthritis in a Child
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چکیده
The blood pressure was 200/90 mmHg in right upper limb and 130/90 mmHg in the left upper limb. It was 145/ 90 mmHg in right lower limb and 140/80 mm Hg in the left lower limb. The radial artery pulse volume was low on the left side. Neck examination revealed a tender and mobile enlarged thyroid. Heart sounds were normal and bruits were detected over the left subclavian artery and abdominal aorta. She had grade II hypertensive retinopathy. ESR and CRP were 18 mm/h, and 10.5 mg/ dL, respectively. Serum creatinine, electrolytes, transaminases and the urinalysis were in normal limits. Human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus were negative. Antinuclear antibody titer was 1:320 in a speckled pattern (low positive), extractable nuclear antigens (ENA) and Cantineutrophilic cytoplasmic antibodies (ANCA) were in normal range. Child was negative for HLA B27 and rheumatoid factor. Tuberculin test was negative. Thyroid scan indicated diffuse hyperplasia. Chest CT scan was normal, ECG showed sinus tachycardia, and an echocardiogram showed mild aortic regurgitation. Digital subtraction angiography (DSA) revealed occlusion of left axillary artery, narrowing of left subclavian artery and right external iliac artery, and proximal stenosis of the left renal arteries. She was diagnosed with Takayasu arteritis type V according to the American College of Rheumatology (ACR) criteria [1], and updated angiographic classification[2]. Prednisolone and antihypertensive agents were added to the aforementioned treatment. This was an unusual association of Takayasu arteritis with Hashiomoto thyroiditis. The pathophysiological mechanism underscoring the association between these two diseases remains unclear. Cell-mediated immunological mechanisms play an important role in both diseases. Pro-inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, IL-12 and IL-18, are common to both, amplifying the inflammatory process [3,4]. In view of the autoimmune features common to TA and HT, it is reasonable to consider the possibility of a pathophysiological association between them.
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