Evidence for early vessel involvement in the dysfunctional myocardium of Takayasu's arteritis

A 15-year-old girl presented with persistent fevers, night sweats, leukocyt osis, an elevated erythrocyte sedimentation rate, and a 13-pound weight los s over 2 months. Duplex Doppler scans, computed tomographic scan, and magne tic resonance imaging studies were suggestive of Takayasu's arteritis. Left ventricular dysfunction occurred during the episode of active disease, and an endomyocardial biopsy demonstrated increased HLA-DR (human leukocyte an tigen-DR) on the endothelium and evidence of immune complex deposition in t he walls of small vessels. One year later, after treatment with corticoster oids and resolution of clinical symptoms, repeat endomyocardial biopsy reve aled focal interstitial fibrosis and persistent immune complex deposition. These results indicate that the inflammatory, vasculitic process affecting the large vessels in Takayasu's arteritis may also involve the endomyocardi um and its small vessels resulting in ventricular dysfunction.