Takayasu arteritis with coronary aneurysms causing acute myocardial infarction in a young man

Abstract

Takayasu arteritis is an inflammatory condition that involves the large cardiac vessels, predominantly the aorta and its main branches. It typically affects young women (age, ≤40 yr), most often Asians and Latin Americans. Herein, we describe a rare manifestation of Takayasu arteritis in a 19-year-old black Tunisian man who presented with acute inferior myocardial infarction and complete atrioventricular block after occlusion from a giant aneurysm in the right coronary artery. The coronary artery disease was associated with aneurysmal dilations in the carotid, vertebral, and right renal arteries. Medical therapy improved Thrombolysis in Myocardial Infarction flow in the area of the giant aneurysm from grade 1 to grade 3. Upon the diagnosis of Takayasu arteritis, intravenous methylprednisolone and oral prednisone therapy was started. After 10 days of hospitalization, the patient was discharged on a medical regimen. Renovascular hypertension due to renal artery stenosis was suspected, so he underwent successful percutaneous transluminal angioplasty of the inferior segmental artery of the right renal artery. During 12 months of close postprocedural monitoring, he experienced lower blood pressure, no chest pain, and no cardiovascular complications.This association of conditions has not been previously reported. Besides presenting this very rare combination of findings, we discuss the differential diagnosis of Takayasu arteritis in our patient.

Keywords: Aortic aneurysm, thoracic/complications/pathology; Takayasu arteritis/classification/diagnosis/drug therapy/ethnology/pathology; arterial occlusive diseases; arteritis/complications; coronary disease/complications/pathology; diagnosis, differential; myocardial infarction/diagnosis; treatment outcome; vasculitis/diagnosis; young adult.

Fig. 1 Electrocardiogram shows ST-segment elevation in the inferior leads and complete atrioventricular block.

Fig. 2 Right coronary angiograms (right anterior oblique projection) show a giant aneurysm. Thrombolysis in Myocardial Infarction (TIMI) flow was grade 1 on day 1 (A), and grade 3 on day 3 (B).

Fig. 3 Left coronary angiogram (left anterior oblique projection) on day 1 shows aneurysmal dilation of the coronary arteries, with wall irregularities in the left circumflex and left anterior descending coronary arteries.

Fig. 4 Follow-up angiogram (right anterior oblique projection) on day 3 shows stenosis above an aneurysmal dilation of the inferior segmental artery of the right renal artery.