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Diana Silva1, Ana Margarida Garcia1, Inês Madureira2, Maria João Brito1

1 - Pediatric Infectious Diseases Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
2 - Rheumatology Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal

- 38th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID 2020)
- International meeting, online conference
- E-poster

Fever of unknown origin is a diagnostic challenge in daily practice. Such patients require a thorough clinical review and a careful and comprehensive approach to diagnosis. Although most underlying causes are common, such as infections, when atypical manifestations are present and the investigation doesn't lead to an obvious diagnosis, infrequent causes should be considered.
Case Presentation: We present a case of a 17 years old female with three months of recurrent fever, refractory anaemia, weight loss (8Kg in 6 months), asthenia, coughing and headache. She also presented skin pallor and an abdominal murmur along the area of the abdominal aorta.
The blood tests carried out revealed microcytic hypochromic anaemia (Hb 9.7x10g/L), high sedimentation rate (120 mm/h) and CRP (85 mg/L). IGRA and HIV, HBV, HCV, EBV and Cytomegalovirus serologies were negative. The chest x-ray showed a mediastinal round hypotransparency and the thoraco-abdominopelvic CT revealed a parietal aortic thickening, probably due to a large vessel vasculitis. Magnetic resonance angiography confirmed the parietal aortic thickening associated with mild stenosis of the left renal artery, likely due to a large vessel vasculitis such as Takayasu arteritis. She was then checked by Cardiology that concluded there was no heart involvement. She started acetyl salicylic acid, corticoids and methotrexate with a good clinical response: the fever stopped, she gained weight and her hemoglobin level increased.
Learning Points/Discussion: Although there are two categories of large vessel vasculitis, only Takayasu Arteritis occurs in paediatric age, but it is extremely rare.
Takayasu Arteritis is a chronic, progressive, inflammatory and occlusive disease of the aorta, its branches and pulmonary artery. Since the clinical manifestations and laboratory examinations are non-specific, accurate diagnosis depends on a high degree of suspicion and appropriate imaging studies.

Palavras Chave: Large vessel vasculites, Recurrent Fever, Takayasu arteritis, Teenager.