Takayasu's Arteritis with Isolated Pulmonary Artery Involvement in a Middle-Aged Asian Woman with Hepatitis B and Latent Tuberculosis Infection

Abstract

We report a rare case of Takayasu's arteritis with isolated pulmonary artery stenosis in the presence of active hepatitis B and latent Mycobacterium tuberculosis infection in a middle-aged Asian woman who initially presented with severe dyspnea on exertion and recurrent syncope, occasional burning chest pains, and fatigue. Therapy of the active hepatitis B and latent M. tuberculosis infection together with a course of methotrexate led to a slight reversal of the symptoms, as angioplasty with or without stenting was not an option. The constellation described here hints at the possible link between hepatitis B and M. tuberculosis infection and the development of Takayasu's arteritis. The case also supports the little evidence available indicating that treatment of active hepatitis B infection could positively influence the course of Takayasu's arteritis.

Takayasu's Arteritis and Its Association With Mycobacterium Tuberculosis: A Systematic Review

“…Over many years, many studies show shreds of evidence implicating the contribution of Mycobacterium tuberculosis in the pathogenesis of TAK [21]. Our studies found 65 cases of latent tuberculosis in patients diagnosed with TAK [11,16,17,[19][20][21][22][23]26,28]. We discovered that the majority of these observational studies detected latent tuberculosis in a patient diagnosed with TAK.…”

“…To better understand the role of Mycobacterium tuberculosis in patients diagnosed with Takayasu's arteritis, we studied 13 previously published articles, which in total included 196 patients diagnosed with Takayasu's arteritis [11,16,17,[19][20][21][22][23][24][25][26][27][28]. Out of which 68 had either a prior or current tuberculous infection [11,16,17,[19][20][21][22][23][24][25][26][27][28].…”

“…We discovered that the majority of these observational studies detected latent tuberculosis in a patient diagnosed with TAK. These studies used various methodologies such as the Mantoux tuberculin skin test, Interferon-g release assay (IGRA), and QuantiFERON-TB tests to detect latent tuberculosis in the study subjects [11,16,17,[19][20][21][22][23]26,28].…”

“…A case report by Liebscher et al presented TAK and infection with Mycobacterium tuberculosis, and hepatitis B [20]. Therapy for these infections and methotrexate led to improvement in TAK symptoms [20].…”

“…A recent case report by Mangouka et al in 2020 reported a case of TAK with latent tuberculosis, which was the first-ever case to be reported in Gabon [ 17 ]. Furthermore, Agostinis et al and Liebscher et al published a case report of TAK with latent tuberculosis in 2019 and 2017, respectively [ 19 , 20 ]. A 75-year-old male diagnosed with TAK and tuberculosis had bilaterally thickened carotid arteries on ultrasound examination, among other symptoms, which showed significant reduction after two weeks of only isoniazid therapy [ 19 ].…”