Management of a patient with Crohn's disease associated with HBV infection and Takayasu's arteritis

Introduction: Although systemic vasculitis is a prominent part of the extraintestinal complications of Crohn's disease, the concomitant occurrence of Takayasu's arteritis associated with Crohn's disease is rare.

Case report: We present a case of a 46-year-old female patient with previously diagnosed hepatitis B virus infection, who was admitted to our department because of repeated abdominal pain, diarrhea, fever, and intestinal bleeding. Investigations revealed Crohn's disease involving the terminal ileum and proximal colon. Beside the observed gastrointestinal symptoms, she complained of pain, numbness, and weakness of the left upper extremity, where also weak pulse could be observed. Duplex Doppler sonography and angiography confirmed stenotic left subclavian and common carotid arteries with typical features for Takayasu's arteritis. The significant stenotic subclavian artery was dilated with percutaneous transluminal balloon angioplasty and stent placement. Combined immunsuppressive treatment containing mesalazine, methylprednisolone and azathioprine controlled the gastrointestinal symptoms. Since the reactivation of hepatitis B virus (HBV) in HBsAg-positive patients is a well-documented complication of immunosuppressive therapy, lamivudine, an inhibitor of reverse transcriptase, was simultaneously given to prevent HBV proliferation. During the treatment, no deterioration of liver parameters was observed.

This case raises the question whether isolated large vessel arteritis could be an unusual feature of Crohn's disease or appeared as a vasculitis due to the HBV infection. Moreover, our case shows that lamivudine is effective in inhibiting HBV proliferation and can be used to prevent HBV flare-up during immunsuppressive treatment in patients with Crohn's disease.