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Case Reports
. 2018 Jul 1;57(13):1929-1934.
doi: 10.2169/internalmedicine.0329-17. Epub 2018 Feb 9.

Takayasu Arteritis Coexisting with Sclerosing Osteomyelitis

Tsuyoshi Shirai  1 , Riiza Hanaoka  1 , Yusuke Goto  1 , Ikuho Kojima  2 , Yusho Ishii  1 , Yousuke Hoshi  1 , Yoko Fujita  1 , Yuko Shirota  1 , Hiroshi Fujii  1 , Tomonori Ishii  1 , Hideo Harigae  1
Affiliations
Case Reports

Takayasu Arteritis Coexisting with Sclerosing Osteomyelitis

Tsuyoshi Shirai et al. Intern Med. .

Abstract

We report a rare case of a 27-year-old woman with Takayasu arteritis (TAK) complicated by diffuse sclerosing osteomyelitis. She first presented with sclerosing osteomyelitis of the right mandible without evidence of arteritis in the carotid arteries. Eight months later, she complained of left neck pain, and imaging studies revealed the presence of arteritis in the left carotid artery. She was diagnosed with TAK, and immunosuppressive treatment was initiated, which was effective for both the arteritis and the osteomyelitis. Osteomyelitis is an important complication of TAK and bone scintigraphy is useful for its detection.

Keywords: Takayasu arteritis; chronic recurrent multifocal osteomyelitis; osteomyelitis; synovitis-acne-pustulosis-hyperostosis-osteitis syndrome.

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Figures

Figure 1.
Figure 1.
Imaging studies at the onset of osteomyelitis. Computed tomography showed an irregular increase in bone density and a periosteal reaction in the right mandible bone (a). Magnetic resonance imaging revealed contrast enhancement in the right mandible bone (b). The carotid artery was normal at this point (c).
Figure 2.
Figure 2.
The bone scintigraphy findings. Bone scintigraphy showed tracer accumulation in the right mandible bone as well as the sternoclavicular joints, first rib, and shoulder joints (arrows).
Figure 3.
Figure 3.
Imaging of arteritis in the left carotid artery. A double ring pattern of wall thickening was observed on contrast computed tomography (a: arterial phase; b: venous phase). Magnetic resonance imaging revealed irregular narrowing of the left carotid artery (c). Positron emission tomography showed mild uptake in the left common carotid artery (d).
Figure 4.
Figure 4.
Improvement on imaging studies. (a, b) Magnetic resonance imaging revealed a reduction in the contrast enhancement in the left carotid artery (a: before treatment; b: after treatment). Bone scintigraphy showed an improvement of the tracer accumulation in the right mandible bone (c).
See this image and copyright information in PMC

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