Takayasu's arteritis as a cause of fever of unknown origin

Article Abstract:

Takayasu's arteritis is an inflammatory disease of the aorta (largest artery, which carries blood from the heart to upper and lower regions of the body) which occludes one or more of its main branches; blood flow to the areas supplied by these branches is diminished and may lead to an absence of pulses. An FUO (fever of unknown origin) is a condition characterized by temperature higher than 101.2 degrees Fahrenheit on several occasions over a duration of three weeks or longer, undiagnosed after a one-week work-up in the hospital. Takayasu's arteritis is not usually seen with fever and has previously been reported only six times as a cause of FUO. This case report describes a 26-year-old white female who was admitted to the hospital with a nine-month history of fever, sweats, weakness, chest pain and headache which began one year earlier after a flu-like illness. She had been diagnosed with anemia and her erythrocyte sedimentation rate (ESR), was elevated, which indicates disease, usually marked by inflammation. Extensive evaluation which included blood tests, CT scans and biopsies was negative during two hospitalizations. The patient was given a two-week trial of prednisone without relief. She lost 20 pounds and her ESR continued to rise. On a follow-up examination it was noted that she had developed asymmetrical pulses and bilateral carotid bruits (abnormal sounds in the carotid arteries of the neck, usually indicative of narrowed vessels). Takayasu's arteritis was suspected and a larger dose of prednisone was prescribed. Her symptoms improved and with restoration of her appetite she regained weight. The diagnosis was confirmed when angiography (x-ray of vessels with the use of radiopaque dye) of the aorta revealed a narrowing of the entire left subclavian artery. Takayasu's arteritis should be considered in cases involving young women with FUO, when all other findings prove negative.

Usage, Diagnosis, Measurement, Causes of, Erythrocytes, Red blood cells, Angiography, Fever, Takayasu's arteritis

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A case of variant angina associated with eosinophilia

Article Abstract:

Eosinophils are white blood cells which contain chemical substances involved in inflammatory and allergic reactions. Eosinophilia (accumulation of an abnormally large number of eosinophils in the blood) is caused by allergic, connective tissue, parasitic and neoplastic (tumor forming) diseases. Hypereosinophilia syndrome, regardless of the cause, may lead to life-threatening problems such as enlargement of the heart, the formation of blood clots in the heart wall, heart valve disease and congestive heart failure. Atherosclerosis (narrowing of the coronary arteries) can result in spasm (coronary vasospasm). Recent data has indicated that chemical substances in the blood may influence coronary vasospasm. This case study describes the unique occurrence of variant angina (pain and constriction about the heart usually due to inadequate oxygen supply to the heart muscle by the coronary arteries) in a 23-year-old male with eosinophilia and hypereosinophilia syndrome who was found to have normal coronary arteries. The patient was admitted to the hospital with cough and difficulty in breathing and was initially diagnosed with bronchial asthma. One year later he began to experience chest pain daily; his electrocardiogram, which measures electrical activity of the heart, indicated inadequate oxygen supply and his pain was relieved by nitroglycerin. Further examination revealed enlargement of the heart, mitral valve prolapse and defective blood perfusion in the left ventricle, the heart's main pumping chamber. The patient's episodes of variant angina were not prevented by antianginal drugs. However, when prednisone, an anti-inflammatory drug, was added to the medication regimen the eosinophil count normalized and the anginal episodes stopped.

Care and treatment, Complications and side effects, Eosinophil disorders

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Supersensitivity of isolated coronary artery to ergonovine in a patient with variant angina

Article Abstract:

Spasms of coronary arteries underlie some heart dysfunctions, such as variant, unstable, and effort anginas and heart attacks, but the causes of such spasms are unclear. Certain vasoconstrictors, such as ergonovine, are used to test susceptibility to spasm in patients with variant angina, or angina at rest caused by coronary artery spasm. It is possible that atherosclerotic coronary arteries may be supersensitive and react more quickly to low doses of ergonovine, or they may be hyperreactive, reacting more strongly to regular ergonovine doses. A case is described of a man who developed coronary artery spasm following ergonovine treatment. After his death, a segment of the same artery was supersensitive to ergonovine. At age 58 the patient was diagnosed with moderate hypertension, and nine years later he suffered a heart attack. He had been in reasonably good health for six years when he developed variant angina, which became worse in spite of medication. Tests revealed obstruction and slight spasm of a coronary artery. The patient then was found to have lung cancer, of which he died at age 74. Following his death, laboratory tests for coronary artery disease and function were conducted as part of the autopsy. Ergonovine, but not the more physiological nerve-secreted hormones serotonin and phenylephrine, caused coronary artery constriction. The thickened, spastic segment of the coronary artery was responsive to one-thousandth of the ergonovine dose to which other artery segments were responsive. This finding suggests that supersensitivity of coronary artery cells to ergonovine and other vasoconstrictors is important in coronary artery spasm. (Consumer Summary produced by Reliance Medical Information, Inc.)

Vasoconstrictors, Vasoconstrictor agents, Ergonovine

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