Tolizumab for the treatment of adolescent patients with aortitis combined with cerebral infarction:a case report and literature review

YANG Jun; DU Rong; WANG Wei-wei; YUAN Xu-jing

doi:10.3969/j.issn.1003-3734.2024.22.009

Abstract：Objective:To report a case of a juvenile patient with Takayasu arteritis complicated with cerebral infarction,successfully treated by combination of tocilizumab,glucocorticoids,and immunosuppressants,and to summarize the literature.Methods:We reported a case of a 15-year-old female patient,with headache,right limb weakness,aphasia with mild facial paralysis symptoms as the first symptom,admission imaging suggested carotid artery and left anterior cerebral artery stenosis,and laboratory tests found that C-reactive protein,erythrocyte sedimentation rate,antinuclear antibody titer,fibrinogen and platelets were elevated.The patient was diagnosed as cephalic brachial artery-type aortitis,and the proposed treatment regimen was tocilizumab(400 mg/dose)combined with glucocorticoid(initial dose of 40 mg·d-1,then gradually reduced)and immunosuppressants(mycophenolate mofetil 250 mg·d-1).The patient was followed up for 4 months.Results:The patient's clinical symptoms was alleviated without serious adverse reactions.In the follow-up,the patient's clinical symptoms improved completely,and the imaging examination showed that the arterial stenosis was better than before,and the laboratory examination showed that the C-reactive protein,erythrocyte sedimentation rate,fibrinogen and platelets returned to normal values,and the titer of antinuclear antibody decreased.The patient's condition was now stable in the ongoing follow-up.Conclusion:The therapeutic regimen of tolizumab combined with glucocorticoids and immunosuppressants demonstrates favorable efficacy and safety profile in patients with arteritis complicated with cerebral infarction.