Takayasu arteritis in childhood: misdiagnoses at disease onset and associated diseases

Takayasu arteritis in childhood: misdiagnoses at disease onset and associated diseases

Author Clemente, Gleice Autor UNIFESP Google Scholar
Silva, Clovis A. Google Scholar
Sacchetti, Silvana B. Google Scholar
Ferriani, Virginia P. L. Google Scholar
Oliveira, Sheila K. Google Scholar
Sztajnbok, Flavio Google Scholar
Bica, Blanca E. R. G. Google Scholar
Cavalcanti, Andre Google Scholar
Robazzi, Teresa Google Scholar
Bandeira, Marcia Google Scholar
Terreri, Maria Teresa Ramos Ascensão Autor UNIFESP Google Scholar
Abstract Juvenile-Takayasu arteritis (j-TA) is a difficult diagnosis and some patients develop uncommon manifestations and associated diseases that may contribute to the delayed diagnosis. Our aim was to identify the misdiagnoses, the associated diseases and the atypical manifestations observed in a j-TA Brazilian multicentre study. 71 children and adolescents who met the classification criteria for j-TA were included. The misdiagnoses, the associated diseases and the atypical manifestations were evaluated. 19 (26.8%) patients had misdiagnoses. The most common of them was aortic coarctation in six (8.4%) patients, followed by rheumatic fever in five (7.0%) and one patient presented with both former diagnoses. Limb pain (two patients), spondyloarthropathy, juvenile idiopathic arthritis (JIA), spinal arteriovenous malformation, polyarteritis nodosa (PAN) and fever of unknown origin (FUO) were other misdiagnoses. Patients who had misdiagnoses previously to j-TA diagnosis presented a trend to have a longer diagnosis delay. 11 (15.5%) patients had 14 TA-associated diseases, such as pulmonary tuberculosis (5 patients), rheumatic fever (2 patients), spondyloarthropathy, polyarticular JIA, Crohn's disease, Prader-Willi disease, diabetes mellitus, Moyamoya and primary immunodeficiency. 7 (9.9%) patients presented 10 atypical manifestations, such as pyoderma gangrenosum, erythema nodosum, myositis, chorea, enthesitis, episcleritis, uveitis, hepatomegaly, splenomegaly and necrosis of extremities. Our study emphasizes the main misdiagnoses, associated diseases and atypical manifestations that occur in patients with j-TA and warns of the features that may alert paediatricians to this diagnosis, such as constitutional symptoms and elevated inflammatory markers.
Keywords Vasculitis
Takayasu arteritis
Childhood
Diagnosis
Adolescent
Language English
Date 2018
Published in Rheumatology International. Heidelberg, v. 38, n. 6, p. 1089-1094, 2018.
ISSN 0172-8172 (Sherpa/Romeo, impact factor)
Publisher Springer Heidelberg
Extent 1089-1094
Origin http://dx.doi.org/10.1007/s00296-018-4030-4
Access rights Closed access
Type Article
Web of Science ID WOS:000432295700017
URI http://repositorio.unifesp.br/handle/11600/46008

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