Clinical Pearls & Morning Reports
Published May 17, 2017
There are six American College of Rheumatology classification criteria for Takayasu’s arteritis. These criteria have over 91% sensitivity and 98% specificity for this diagnosis. Read the latest Case Record of the Massachusetts General Hospital.
Q. What is one of the modes of transmission of brucellosis?
A. Brucellosis is a bacterial infection that is endemic in northern Africa. Camels and goats are reservoirs of the gram-negative bacillus that causes this disease, and the consumption of undercooked, unpasteurized milk products from these animals is a common mode of transmission.
Q. What is the name of the organism that causes melioidosis and what are some of its clinical manifestations?
A. Burkholderia pseudomallei is the gram-negative bacillus that causes melioidosis. Clinical manifestations of melioidosis are frequently similar to those of mycobacterial infections; bacteremia can occur, and multiple organs, including the skin, can be involved. Most patients with melioidosis have coexisting conditions, such as heavy alcohol use, lung disease, or advanced diabetes. Pneumonia is the most common clinical finding in patients with melioidosis.
A: Giant-cell arteritis and Takayasu’s arteritis are both inflammatory vasculitides that are associated with inflammation of the large arteries, granulomatous changes, and an indolent course with involvement of multiple organs, and the features of each disease may mimic those of several other infectious diseases. Giant-cell arteritis tends to occur in adults older than 50 years of age. It tends to involve the carotid arteries and their major branches and is classically manifested by headache, jaw claudication, scalp tenderness, and visual deficits. In contrast, Takayasu’s arteritis most commonly affects females younger than 40 years of age. Patients with Takayasu’s arteritis have loss of peripheral pulses that is related to involvement of the aorta and its major arterial branches. In addition, granulomatous reactions involving multiple organs, including the skin and visceral organs, are well described.
A: Glucocorticoids are the mainstay of treatment, but relapses are frequent, and it is important to consider the complications associated with glucocorticoid exposure, especially at high doses for prolonged periods. Conventional disease-modifying antirheumatic drugs (e.g., methotrexate, azathioprine, and leflunomide) have been used, but a growing body of literature suggests that tumor necrosis factor inhibitors (e.g., infliximab) and interleukin-6 inhibition with tocilizumab may be more effective.