Crohn’s disease and Takayasu’s arteritis: An uncommon association

Abstract

Takayasu’s arteritis (TA) and Crohn’s disease (CD) are two rare autoimmune disorders; however some reports describe the presence of both diseases in the same patient. This finding has suggested the possibility that both diseases could share some common etiologic origin. We describe a case of a 13-year-old male affected by CD characterized by fever, diarrhea, weight loss, abdominal pain and elevation of inflammatory markers. Clinical and histological features from colonic specimens were consistent with CD. Treatment with steroids and azathioprine was started, however disease flared every time steroids were tapered. One year later, while still on treatment, he came back to our attention for dyspnea at rest and at night, tiredness and weakness. At physical examination a diastolic heart murmur was found as well as a left carotid artery bruit. A transthoracic echocardiography showed mild aortic valve insufficiency, left ventricular hypertrophy and a dilated ascending aorta with same findings at the aortic arch. A computed tomography scan showed abdominal aorta thickening, dilated thoracic aorta and the presence of a thoracic aortic aneurysm. TA associated with CD was diagnosed and medical treatment with cyclophosphamide, steroids and aminosalicylic acid was started, with good clinical response at 6 mo follow-up. We discuss the presence of possible common causes for the two diseases and the importance of differential diagnosis in those patients characterized for intractable disease.

Keywords: Crohn’s disease; Takayasu arteritis; Intractable inflammatory bowel disease; children; Treatment

Core tip: It is known that both Takayasu’s arteritis (TA) and Crohn’s disease (CD) can present together in the same patient although this association is considered extremely rare. We would like to underline the importance of considering an alternative diagnosis in those patients characterized by intractable diseases; in our case, in fact, an intractable CD masked TA and the patient did not achieve clinical remission until he was treated with major immunosupressive therapy; a treatment which can not be considered a standard protocol for CD.