Case Report: Co-existence of sarcoidosis and Takayasu arteritis

Abstract

Takayasu arteritis is a rare systemic large vessel vasculitis affecting the aorta and its branches. Sarcoidosis, too, is an inflammatory disease. Both entities are granulomatous conditions with a questionable association in their etiopathogenesis. Only a few cases of their coexistence have been reported in the literature. To our knowledge, no such cases have been reported from Nepal. We report a Nepalese woman who presented with non-productive cough, progressive shortness of breath and chest tightness of 3 years duration. She had a history of recurrent bilateral granulomatous uveitis over the previous 3 years. Examination revealed clubbing of digits, absent pulses over the left radial, ulnar and brachial arteries, and a weak pulse over the right arm including the bilateral carotid arteries. Pulmonary function test showed restrictive pattern, a high-resolution computed tomography (HRCT) scan of the chest revealed findings suggestive of pulmonary sarcoidosis. A CT angiogram suggested large vessel vasculitis. Bronchoscopy with biopsy revealed granulomatous inflammation, negative for malignancy and tuberculosis. She was hence, diagnosed with co-existing Takayasu arteritis and sarcoidosis, and treated with Prednisolone 60 mg once daily with dramatic improvement over 4 days and was discharged stable on domiciliary oxygen. She is currently on azathioprine 50 mg, prednisolone 10 mg without the need for supplemental oxygen. This case report highlights the importance of a proper physical examination as a guide to the use of modern technology in making a correct diagnosis. Furthermore, in countries where tuberculosis is endemic, it should always come as the most important differential diagnosis of granulomatous inflammation.

Integrative single-cell analysis of cardiac and pulmonary sarcoidosis using publicly available cardiac and bronchoalveolar lavage fluid sequencing datasets

“…This is supported by studies that showed that cardiomyocytes in CS patients upregulate the expression of tissue factor pathway inhibitor (TFPI) which is implicated in IL-1 signaling as well as angiogenesis (49). In addition, there have been several case reports describing CS patients who develop vasculitis towards the end-stage of their disease (50,51). This suggests that CS might be mediating this endothelial cell inflammation.…”

Vasculitis in Patients With Sarcoidosis

“…Multiple case reports and small case series have documented that the inflammatory dysregulation in sarcoidosis can lead to vasculitis 3–15 . The most common vasculitic manifestation is cutaneous vasculitis, although published case reports indicate that any vessel size can be impacted 5,12,15 .…”

“…2 Multiple case reports and small case series have documented that the inflammatory dysregulation in sarcoidosis can lead to vasculitis. [3][4][5][6][7][8][9][10][11][12][13][14][15] The most common vasculitic manifestation is cutaneous vasculitis, although published case reports indicate that any vessel size can be impacted. 5,12,15 Cutaneous manifestations of vasculitis in patients with sarcoidosis include palpable purpura, ulcerations, bullous formation, and the development of nodules.…”