A rare case of takayasu arteritis induced renovascular hypertension in a patient with crohn disease.

Takayasu arteritis (TA) is chronic inflammatory arteritis affecting large vessels, predominantly the aorta and its main branches. Vascular inflammation occurs wall thickening, fibrosis and stenosis. Arterial stenosis due to TA often causes secondary hypertension. Crohn disease (CD) is chronic granulomatous, inflammatory gastrointestinal disease, It can cause various extraintestinal complications. A few case reports and small case series reported complications of TA and CD. In recently, there are several reports that TA are revealed in patients treated with anti-tumor necrosis factor - alpha antibody for CD. We report a 18 years old male in whom TA was manifested mainly by severe hypertension and proteinuria after infliximab administration for CD. He was diagnosed with CD at the age of 17. He had a great fever and high CRP levels (6.55 mg/dl), and endoscopic examination revealed multiple longitudinal ulcers in the large intestine and ileum. Although, he was treated with adalimumab and 5 -aminosalicylic acid, fever and CRP levels did not improve, Infliximab was administered. Following infliximab administration, his laboratory data revealed renal impairment (blood urea nitrogen level: 13 mg/dl, creatinine level: 1.28 mg/dl), proteinuria (10.0 g/gCr) and he had severe hypertension (about 190/100 mmHg). Both, his plasma aldosterone concentration (PAC) (RIA) and plasma renin activity (PRA) were significantly high (PAC: 798 pg/ml. PRA: 66.2 ng/ml/hr). In addition, magnetic resonance angiography and radioisotope renogram findings revealed stenoses of the right renal artery. Although, a simple CT scan performed 5 months earlier showed no abnormalities in both kidney, contrast-enhanced CT revealed stenoses of the right renal artery, superior mesenteric artery, right renal atrophy, and left renal enlargement. The 99mTc-DTPA Renography reveled severe right renal dysfunction (GFR 14.67/61.21 ml/min). Based on these findings, patient was diagnosed with TA induced renovascular hypertension complicated with CD, and oral administration of prednisolone from 1 mg/kg/day and antihypertensive drugs (amlodipine, doxazosin, and spironolactone) was started. After 14 days treatment, his blood pressure was about 170/90 mmHg. Finally, losartan was administered, his blood pressure was reduced to 120∼150/70∼90 mmHg, and no changes in his serum creatinine levels was observed. We report with a review of the literature.