Takayasu – Arteriitis nach COVID-19-Infektion bei einer 26 Jahre alten Patientin mit Morbus Crohn

Zusammenfassung

Extraintestinale Manifestationen z.B. an Haut, Gelenken oder Leber finden sich bei Morbus Crohn häufig. Wir berichten über eine 26 Jahre alte Patientin mit langjährig bekanntem Morbus Crohn, die bei V.a. erneuten akuten Schub bei suggestiver Klinik und laborchemisch deutlich erhöhten Entzündungswerten stationär aufgenommen wurde. Kurze Zeit vorher war die Diagnose einer symptomatischen COVID-19-Erkrankung (SARS-CoV-2-Variante Omikron) gestellt worden. Mittels umfassender endoskopischer und bildgebender Diagnostik konnte eine aktive Crohn-Erkrankung ausgeschlossen werden. Es zeigte sich jedoch eine langstreckige entzündliche Verdickung des Aortenbogens, sodass die Diagnose einer Takayasu-Arteriitis (Typ II b) gestellt werden konnte. Unter Steroidtherapie kam es zu einer raschen und anhaltenden Besserung der klinischen Symptomatik. Das Auftreten einer Takayasu-Arteriitis ist außerhalb von Japan ausgesprochen selten. Eine Koinzidenz mit chronisch entzündlichen Darmerkrankungen ist beschrieben und wird als mögliche extraintestinale Manifestation diskutiert. Das Auftreten immunvermittelter Erkrankungen nach COVID-19-Erkrankungen ist beschrieben und wird möglicherweise durch die Infektion getriggert. Patienten mit chronisch entzündlichen Darmerkrankungen könnten möglicherweise eine besondere Risikopopulation darstellen.

Abstract

Extraintestinal manifestations, e.g. of the skin, joints or liver, are frequently found in Crohn’s disease. We report about a 26-year-old female patient with longstanding Crohn’s disease, who was admitted to our hospital with suspicion of an acute attack with suggestive symptoms and increased significantly inflammatory parameters. Shortly before, symptomatic COVID-19 disease (SARS-CoV-2 variant omicron) had been made. Comprehensive endoscopic and imaging diagnostics ruled out active Crohn’s disease. However, inflammatory thickening of the aortic arch was seen, and a diagnosis of Takayasu arteritis (type II b) was made. Steroid therapy resulted in a rapid and sustained improvement of clinical symptoms. The occurrence of Takayasu arteritis is extremely rare outside Japan. An coincidence has been described in chronic inflammatory bowel diseases and is discussed as a possible extraintestinal manifestation. The occurrence of immune-mediated disease after COVID-19 disease has been described and may be triggered by the infection. Patients with inflammatory bowel disease may represent a special risk population.

Schlüsselwörter

Autoimmunität - COVID-19 - Morbus Crohn - SARS-CoV-2-Variante Omikron - Takayasu-Arteriitis (TAK)

Keywords

Autoimmunity - COVID-19 - Crohn’s disease - SARS-CoV-2-Variante Omicron - Takayasu arteriitis (TAK)

Publication History

Received: 23 September 2023

Article published online:
28 February 2024

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