A 20‐year‐old African American male presented to the hospital for recurrent episodes of severe, diffuse crampy abdominal pain, fatigue, anorexia, vomiting, watery diarrhea, and a 20‐pound weight loss over 2 months. Although he had a 5‐year history of ulcerative colitis (UC) confirmed by colonoscopy and biopsy, with flares 1‐2 Times per year, he described his recent 2 months of symptoms as unlike his prior UC flares. Hypertension was recently diagnosed and difficult to control on multiple medications. Physical exam revealed a well‐appearing young male, blood pressure 146/90 on medications. Femoral and radial pulses were strong and symmetric. His abdomen was not tender to palpation despite subjective pain. No carotid or abdominal bruits were auscultated. Labs showed negative ANA, rheumatoid factor, and ANCA and normal CRP and ESR. Lactic acid was mildly elevated at 2.8 mmol/L. Computed tomography angiogram (CTA), ordered for concern of bowel ischemia, showed circumferential Thickening of The abdominal aorta and narrowing of The superior mesenTeric artery and bilateral renal arteries consistent with Takayasu's arteritis (TA). Colonoscopy revealed chronic colitis with focal activity consistent with ulcerative colitis at the sigmoid colon and rectum and proven by biopsy.
The association between inflammatory bowel disease (IBD), specifically UC, with TA has been previously reported in the literature. Most of the reported cases involved females of Asian descent, in whom the incidence of TA is relatively high. Our case is the first reported case of an African American with both UC and TA and only the third such reported case with both IBD and TA in an African American. Although rare, several studies and literature reviews show higher‐than‐expected concurrence of IBD and TA (7%‐9%), especially since the incidence of both diseases is low. This association suggests a noncoincidental relationship and has stirred various possible etiologies including genetic, immunological, and infectious. This association may be more common than identified in published reports, as treatment modalities overlap for both diseases and could disguise or delay diagnosis of one or the other. Thus, until a pathogenic association is either proven or disproven, we suggest that arteritis should be considered in the differential diagnosis of an atypical IBD presentation or with other coexistent unexplained systemic manifestations in an IBD patient, such as neurologic symptoms or hypertension.
In our case, hypertension was likely renovascular in etiology, underscoring the notion of secondary hypertension as a warning sign of arteritis. Clinical suspicion of Takayasus arteritis may facilitate early diagnosis in IBD patients, allowing early therapeutic intervention and preventing irreversible ischemic injury.
R. Ramadan, none; D. Dressier, none.
To cite this abstract:Ramadan R, Dressier D. Surreptitious Takayasu's Arteritis in a Young African American Male with Ulcerative Colitis. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 337. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/surreptitious-takayasus-arteritis-in-a-young-african-american-male-with-ulcerative-colitis/. Accessed October 17, 2019.