Neuroimaging of Takayasu Arteritis in a Patient with Ulcerative Rectocolitis

Takayasu arteritis (TA), also known as aortoarteritis and pulseless disease, is an autoimmune, idiopathic, large-vessel vasculitis that primarily affects the aorta and its major branches, the coronary arteries, and the pulmonary arteries.

This is a peculiar clinical and radiological pattern of TA in a young female Caucasian. Her medical history included diagnosis of ulcerative rectocolitis at the age of 14. Because of the occurrence of anemia and exacerbation of rectocolitis, she had started infliximab associated with low doses of cortisone and mesalazine. Three months before admission, therapy with infliximab was discontinued because of the onset of fever, sore throat, and the increase in the neck pain. Imaging is crucial to achieve a proper diagnosis and the main differential diagnosis of this setting is arterial dissection. Magnetic resonance angiography (MRA) and color Doppler sonography (CDS) have been able to demonstrate rare but possible arteriovenous fistula in TA patients. This is the first report on arteriovenous fistula of cervical venous plexus in TA patients.

(1) TA has to be suspected in young woman with neck pain, even without neurological symptoms. (2) Magnetic resonance imaging and CDS can depict wall thickening and abnormal caliber in the involved vessels. (3) MRA and CDS are able to demonstrate rare but possible arteriovenous fistula in TA patients. (4) Rectocolitis therapy could be a trigger factor of wall vessel involvement.