Takayasu’s arteritis with involvement of small cutaneous vessels - with regard to a clinical case

Maria C. Fialho, Dermatology and Venereology Department, Hospital de Santo António dos Capuchos, Unidade Local de Saúde de São José, Lisbon, Portugal Sara Castro, Internal Medicine Department, Hospital Curry Cabral, Unidade Local de Saúde de São José, Lisbon, Portugal Sara Dias, Internal Medicine Department, Hospital Curry Cabral, Unidade Local de Saúde de São José, Lisbon, Portugal Ricardo Veiga, Dermatology and Venereology Department, Hospital de Santo António dos Capuchos, Unidade Local de Saúde de São José, Lisbon, Portugal Ana Ferreirinha, Dermatology and Venereology Department, Hospital de Santo António dos Capuchos, Unidade Local de Saúde de São José, Lisbon, Portugal Emanuel Marques, Dermatology and Venereology Department, Hospital de Santo António dos Capuchos, Unidade Local de Saúde de São José, Lisbon, Portugal;; Dermatology and Venereology Department, NOVA Medical School, Nova University, Lisbon, Portugal Cândida Fernandes, Dermatology and Venereology Department, Hospital de Santo António dos Capuchos, Unidade Local de Saúde de São José, Lisbon, Portugal

Takayasu’s arteritis (TA) is a vasculitis that affects large vessels. Rarely, microcirculation is involved, sometimes with cutaneous manifestations. Inflammation of small vessels of the skin can present as erythema nodosum-like lesions and granulomatous cutaneous vasculitis, among others. We describe the case of a 29-year-old woman with a diagnosis of TA confirmed by angio-CT. She was referred to a dermatology appointment due to a skin condition characterized by centimetric, erythematous, painful, and nonulcerated nodules on the soles and inner edges of the feet. Clinical and analytical criteria of active disease were met, despite implemented corticotherapy. Cutaneous biopsy showed panniculitis and leukocytoclastic vasculitis. Autoimmune vasculitis and cryoglobulinemia panels were negative. Erythema nodosum-like subcutaneous nodules have been described in TA, possibly preceding other disease manifestations or as markers of disease activity. An early correlation with constitutional and cardiovascular symptoms may lead to earlier diagnosis and prompt control of disease activity.Takayasu’s arteritis (TA) is a vasculitis that affects large vessels. Rarely, microcirculation is involved, sometimes with cutaneous manifestations. Inflammation of small vessels of the skin can present as erythema nodosum-like lesions and granulomatous cutaneous vasculitis, among others. We describe the case of a 29-year-old woman with a diagnosis of TA confirmed by angio-CT. She was referred to a dermatology appointment due to a skin condition characterized by centimetric, erythematous, painful, and nonulcerated nodules on the soles and inner edges of the feet. Clinical and analytical criteria of active disease were met, despite implemented corticotherapy. Cutaneous biopsy showed panniculitis and leukocytoclastic vasculitis. Autoimmune vasculitis and cryoglobulinemia panels were negative. Erythema nodosum-like subcutaneous nodules have been described in TA, possibly preceding other disease manifestations or as markers of disease activity. An early correlation with constitutional and cardiovascular symptoms may lead to earlier diagnosis and prompt control of disease activity.

Keywords: Small vessel vasculitis. Large vessel vasculitis. Cutaneous vasculitis. Granulomatous panniculitis. Takayasu’s arteritis.