Oclusão Completa do Arco Aórtico em Paciente Portadora de Arterite de Takayasu e Espondilite Anquilosante / Total Aortic arch Occlusion in a Patient with Takayasu's Arteritis and Spondylitis Ankylosans
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Abstract
Introdução: A Arterite de Takayasu (AT) é uma vasculite que acomete a aorta e seus principais ramos, principalmente as artérias carótidas e subclávias. A espondilite anquilosante (EA) por sua vez é uma doença inflamatória crônica, que acomete preferencialmente a coluna vertebral, evoluindo com rigidez e limitação funcional progressiva do esqueleto axial. A associação dessas duas doenças é rara e de difícil diagnóstico. Casuística: Relata-se o caso de uma paciente do sexo feminino, 49 anos, apresentando dor e rigidez da coluna vertebral, cefaleia, vertigem, ausência de pulsos em membros superiores e hipertensão arterial sistêmica. A Angio-TC de aorta revelou oclusão dos troncos
supra-aórticos (TSA) e sinais de espondilopatia, caracterizados por sindesmófitos entre os corpos vertebrais e sinais de anquilose da articulação sacroilíaca. A angiografia por subtração digital confirmou a oclusão completa dos TSA em suas origens e extensa circulação colateral. Foi iniciado tratamento com imunosupressores e corticoide, além de tratamento da hipertensão arterial sistêmica, observando-se redução dos níveis pressóricos e melhora da cefaleia, porém com manutenção da dor lombar e do enrijecimento articular. Conclusão: A ocorrência concomitante de duas doenças aparentemente distintas como a AT e a EA deve ser interpretada como a manifestação de um estado inflamatório sistêmico de etiologia ainda não totalmente definida.
Palavras-chave: Arterite de Takayasu, Espondilite Anquilosante, Aorta Torácica, Angiografia Digital, Aortografia, Tomografia Computadorizada por Raios X.
ABSTRACT
Introduction: Takayasu Arteritis (TA) is a large-vessel vasculitis that affects the aorta and its main branches, especially the carotid and subclavian arteries. Ankylosing Spondylitis (AS) in turn is a chronic inflammatory disease, that mainly affects the spine, evolving with stiffness and progressive functional limitation of the axial skeleton. The association of these two diseases is rare and difficult to diagnose. Case Report: We report the case of a female patient, 49 years, with pain and stiffness of the spine, headache, dizziness, absence of pulses in the upper limbs and systemic hypertension. The CT angiography revealed occlusion of the aorta of the supra-aortic trunks (SAT) and signals of spondylopathy, characterized by syndesmophytes between vertebral bodies and signs of ankylosis of the sacroiliac joint. The digital subtraction angiography confirmed a complete occlusion of the TSA in its origins and extensive collateral circulation. Treatment was started with immunosuppressants and corticosteroids, and treatment of hypertension, with a reduction in blood pressure and improvement of headache, although a maintenance of low back pain and joint stiffness was observed. Conclusion: The simultaneous occurrence of two seemingly distinct diseases such as TA and AS should be interpreted as the manifestation of a systemic inflammatory condition of unknown etiology not yet fully defined.
Keywords: Takayasu Arteritis, Ankylosing Spondylitis, Thoracic Aorta, Digital Subtraction Angiography, Aortography, X-Ray Computed Tomography.
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