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Acute panuveitis in a child with Takayasu’s arteritis

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Takayasu’s arteritis is a panarteritis involving the intima, media, and adventitia of the larger vessels of the neck, thorax, and abdomen. It is most common in southeast Asia, affects women more than men, and rarely affects children. It may cause ischaemic optic neuropathy but has rarely been associated with inflammatory eye disease. A boy in Australia developed acute panuveitis with Takayasu’s arteritis.

At presentation the 12 year old boy, who was of Chinese origin, had a two day history of low grade fever, occipital headache, nausea, and vomiting. His blood pressure was 180/110 mm Hg and temperature 39.9° C but he otherwise appeared well and fundoscopy and visual acuity were normal. Erythrocyte sedimentation rate was 93 mm/hour and serum creatinine 85 μmol/l. His hypertension was controlled with four drugs. Renal Doppler ultrasound and magnetic resonance angiography (MRA) of neck, chest, and abdomen indicated bilateral renal artery stenosis but no other vascular abnormality. Renal angiography confirmed severe stenosis of only the left renal artery and his hypertension resolved after balloon angioplasty. He subsequently developed bilateral anterior uveitis and was treated with steroid eye drops and cycloplegics. Two months later he developed panuveitis and upper limb and carotid pulses were weak. MRA showed severe stenosis of the origin of the left vertebral artery and both subclavian arteries. A diagnosis of Takayasu’s arteritis was made and he was given intravenous methylprednisolone followed by eight weeks of oral prednisolone, cyclophosphamide, and aspirin and then maintenance treatment with methotrexate and low dose prednisolone. He developed chronic uveitis in the left eye but remained normotensive and the arterial stenoses improved.

This case is unique in that there was panuveitis without glaucomatous ischaemic changes and with negative antineutrophil cytoplasmic antibody (ANCA) tests and no evidence of sarcoidosis, Wegener’s granulomatosis, or Cogan’s disease.

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