An asymptomatic 62-year-old woman presented for a routine annual examination and was
found to have elevated sedimentation rate and C-reactive protein. Physical examination
was normal except for a difference in blood pressure between arms (120/74 on the right
and 110/76 on the left). Computed tomography (CT) scan demonstrated an aortitis, and
positron emission tomography–CT scan confirmed the presence of active inflammatory
disease. She received prednisone 40 mg daily for 30 days, but discontinued the treatment
because of multiple side effects.
One year later, she presented with severe intermittent abdominal pain, which was worst
when lying flat. She had anorexia and lost several pounds. Results from ultrasonography
and basic laboratory studies were unremarkable other than elevation of acute phase
reactants and anemia. Upper gastrointestinal endoscopy revealed gastritis. Colonoscopy
showed patchy submucosal hemorrhagic lesions in the right colon.
Capsule endoscopy showed diffuse and continuous involvement of the jejunal mucosa,
with edema, reddish patches, and erosions ([Fig. 1], [Video 1]). Ischemic manifestation of a large vessel vasculitis (Takayasu’s arteritis) was
suspected.
Fig. 1 Video capsule endoscopy images. Diffuse and continuous involvement of the jejunal
mucosa was seen, with edema, reddish patches, and erosions.
Video 1 Video capsule endoscopy diagnosis of Takayasu’s arteritis.
CT angiogram revealed a dramatic distribution of vascular disease: severe stenosis
of the celiac artery, 99 % occlusion of the superior mesenteric artery, 50 % – 60 %
occlusion of the inferior mesenteric artery, significant stenosis of the right renal
artery, and 70 % – 80 % occlusion of the left renal artery ([Fig. 2]).
Fig. 2 Imaging showed a dramatic distribution of vascular disease: severe stenosis of the
celiac artery, 99 % occlusion of the superior mesenteric artery, 50 % – 60 % occlusion
of the inferior mesenteric artery, significant stenosis of the right renal artery,
and 70 % – 80 % occlusion of the left renal artery. a Computed tomography (CT) angiogram; b CT scan showing aortitis.
Takayasu’s arteritis is a chronic inflammatory disorder primarily located in the aorta
and its major branches, with recent updates of the classification criteria including
large mesenteric vessels [1]. It is a disease of young women, although a mild course may become clinically overt
beyond the age of 40, which is one of the major criteria. It is a rare disease (1 – 3
patients per million per year) [1]. Gastrointestinal involvement is observed in organs that are dependent on the large
branches of the abdominal aorta, such as the upper mesenteric artery [2]
[3].
To our knowledge, this is the first report of Takayasu’s arteritis diagnosed by video
capsule endoscopy.
Endoscopy_UCTN_Code_CCL_1AC_2AH
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
