A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation
Background. Takayasu’s arteritis with comorbid chronic recurrent multifocal osteomyelitis and ulcerative colitis is rare in the pediatric population. Treatment with anti-TNF alpha agents such as infliximab has been a successful treatment strategy in adults and can be used effectively in the pediatri...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-01-01
|
| Series: | Case Reports in Rheumatology |
| Online Access: | http://dx.doi.org/10.1155/2019/8157969 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849434996834566144 |
|---|---|
| author | Viveka Clare De Guerra Humaira Hashmi Bree Kramer Rula Balluz Mary Beth Son Deborah Stein Alicia Lieberman Mahmoud Zahra Rabheh Abdul-Aziz |
| author_facet | Viveka Clare De Guerra Humaira Hashmi Bree Kramer Rula Balluz Mary Beth Son Deborah Stein Alicia Lieberman Mahmoud Zahra Rabheh Abdul-Aziz |
| author_sort | Viveka Clare De Guerra |
| collection | DOAJ |
| description | Background. Takayasu’s arteritis with comorbid chronic recurrent multifocal osteomyelitis and ulcerative colitis is rare in the pediatric population. Treatment with anti-TNF alpha agents such as infliximab has been a successful treatment strategy in adults and can be used effectively in the pediatric population. Case Presentation. We present the case of a 15-year-old Caucasian girl with a history of chronic recurrent multifocal osteomyelitis and ulcerative colitis presenting with hypertensive emergency secondary to Takayasu’s arteritis with middle aortic syndrome. She was treated with corticosteroids and methotrexate and ultimately required infliximab infusions of 15 mg/kg every 4 weeks to successfully control her symptoms and normalize her inflammatory markers. Conclusions. In this case, we discuss the use of infliximab in an adolescent patient with chronic recurrent multifocal osteomyelitis, ulcerative colitis, and Takayasu’s arteritis. The significance of this case is determined by the unique occurrence of all three conditions in a pediatric patient, the important consideration of vasculitis in the differential of a pediatric patient presenting with hypertensive emergency, the need for vigilance for detecting diagnostic clues, signs, and symptoms, knowledge of disease associations when evaluating a patient with a predisposition for autoinflammatory conditions, and the use of increasing doses of infliximab to control symptoms. |
| format | Article |
| id | doaj-art-e48a95959b8048fcaafc244599e09701 |
| institution | Kabale University |
| issn | 2090-6889 2090-6897 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Rheumatology |
| spelling | doaj-art-e48a95959b8048fcaafc244599e097012025-08-20T03:26:26ZengWileyCase Reports in Rheumatology2090-68892090-68972019-01-01201910.1155/2019/81579698157969A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune DysregulationViveka Clare De Guerra0Humaira Hashmi1Bree Kramer2Rula Balluz3Mary Beth Son4Deborah Stein5Alicia Lieberman6Mahmoud Zahra7Rabheh Abdul-Aziz8Department of Pediatrics, University at Buffalo, Oishei Children’s Hospital, 1001 Main Street, Buffalo, NY 14203, USAWestern New York Pediatric Gastroenterology, 166 Washington Avenue, Batavia, NY 14020, USADepartment of Pediatrics, University at Buffalo, Oishei Children’s Hospital, 1001 Main Street, Buffalo, NY 14203, USADepartment of Pediatrics, University at Buffalo, Oishei Children’s Hospital, 1001 Main Street, Buffalo, NY 14203, USADepartment of Pediatric Rheumatology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USADepartment of Pediatric Nephrology, Center for Midaortic Syndrome and Renovascular Hypertension, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USADepartment of Pediatric Rheumatology, Strong Memorial Hospital at the University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USADepartment of Pediatrics, University at Buffalo, Oishei Children’s Hospital, 1001 Main Street, Buffalo, NY 14203, USADepartment of Pediatrics, University at Buffalo, Oishei Children’s Hospital, 1001 Main Street, Buffalo, NY 14203, USABackground. Takayasu’s arteritis with comorbid chronic recurrent multifocal osteomyelitis and ulcerative colitis is rare in the pediatric population. Treatment with anti-TNF alpha agents such as infliximab has been a successful treatment strategy in adults and can be used effectively in the pediatric population. Case Presentation. We present the case of a 15-year-old Caucasian girl with a history of chronic recurrent multifocal osteomyelitis and ulcerative colitis presenting with hypertensive emergency secondary to Takayasu’s arteritis with middle aortic syndrome. She was treated with corticosteroids and methotrexate and ultimately required infliximab infusions of 15 mg/kg every 4 weeks to successfully control her symptoms and normalize her inflammatory markers. Conclusions. In this case, we discuss the use of infliximab in an adolescent patient with chronic recurrent multifocal osteomyelitis, ulcerative colitis, and Takayasu’s arteritis. The significance of this case is determined by the unique occurrence of all three conditions in a pediatric patient, the important consideration of vasculitis in the differential of a pediatric patient presenting with hypertensive emergency, the need for vigilance for detecting diagnostic clues, signs, and symptoms, knowledge of disease associations when evaluating a patient with a predisposition for autoinflammatory conditions, and the use of increasing doses of infliximab to control symptoms.http://dx.doi.org/10.1155/2019/8157969 |
| spellingShingle | Viveka Clare De Guerra Humaira Hashmi Bree Kramer Rula Balluz Mary Beth Son Deborah Stein Alicia Lieberman Mahmoud Zahra Rabheh Abdul-Aziz A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation Case Reports in Rheumatology |
| title | A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation |
| title_full | A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation |
| title_fullStr | A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation |
| title_full_unstemmed | A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation |
| title_short | A Case Report of Takayasu’s Arteritis and Ulcerative Colitis in a Pediatric Patient with Chronic Recurrent Multifocal Osteomyelitis Successfully Treated with Infliximab: Diagnostic Clues in Disease Associations and Immune Dysregulation |
| title_sort | case report of takayasu s arteritis and ulcerative colitis in a pediatric patient with chronic recurrent multifocal osteomyelitis successfully treated with infliximab diagnostic clues in disease associations and immune dysregulation |
| url | http://dx.doi.org/10.1155/2019/8157969 |
| work_keys_str_mv | AT vivekaclaredeguerra acasereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT humairahashmi acasereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT breekramer acasereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT rulaballuz acasereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT marybethson acasereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT deborahstein acasereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT alicialieberman acasereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT mahmoudzahra acasereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT rabhehabdulaziz acasereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT vivekaclaredeguerra casereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT humairahashmi casereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT breekramer casereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT rulaballuz casereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT marybethson casereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT deborahstein casereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT alicialieberman casereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT mahmoudzahra casereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation AT rabhehabdulaziz casereportoftakayasusarteritisandulcerativecolitisinapediatricpatientwithchronicrecurrentmultifocalosteomyelitissuccessfullytreatedwithinfliximabdiagnosticcluesindiseaseassociationsandimmunedysregulation |