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Letter
Benefit of immunosuppression for severe Takayasu’s arteritis and coincident primary biliary cirrhosis
  1. E Feist1,
  2. K G A Hermann3,
  3. S Filimonow3,
  4. R I Rückert2,
  5. T Dörner1,
  6. F Hiepe1
  1. 1Department of Rheumatology and Clinical Immunology, Charité University Hospital, Humboldt University of Berlin, Schumannstr 20/21, 10117 Berlin, Germany
  2. 2Clinic of General, Visceral, Vascular, and Thoracic Surgery, Charité University Hospital, Humboldt University of Berlin, Schumannstr 20/21, 10117 Berlin, Germany
  3. 3Department of Radiology, Charité University Hospital, Humboldt University of Berlin, Schumannstr 20/21, 10117 Berlin, Germany
  1. Correspondence to:
    Dr E Feist
    eugen.feistcharite.de

https://doi.org/10.1136/ard.2003.013722

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    Takayasu’s arteritis and primary biliary cirrhosis (PBC) are two unrelated autoimmune diseases without a so far reported coincidence, probably because they occur at different ages.1,2 As a systemic vasculitis, Takayasu’s arteritis affects predominantly the aorta and its branches in female patients before the age of 40 years. The clinical manifestations are variable and severe anatomical lesions can lead to life threatening ischaemia. We report an unusual case, where, after the initial diagnosis of a coincident severe Takayasu’s arteritis with PBC, subsequent immunosuppressive treatment led to a striking clinical improvement of vasculitic symptoms in an elderly woman.

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    A 70 year old woman was referred to our hospital with generalised weakness and disseminated painful cutaneous, erythematous nodules on the extensor sites of both lower legs. A rheumatic disorder had been suspected since 1960 because of remittent nausea, attacks of fulminant headaches, and an erythema nodosum. Clinical examination showed a diminished bilateral radial and an absent carotid pulse as well as hypotensive blood pressure on both arms (85/60 and 90/60 mm …

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