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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 19-21

A rare case of tuberculosis along with abdominal aorto arteritis in young women


Department of Medicine, M R Medical College, Kalaburagi, Karnataka, India

Date of Submission19-Jul-2019
Date of Acceptance16-Sep-2019
Date of Web Publication14-Jan-2020

Correspondence Address:
Dr. Sangram Biradar
Department of Medicine, M R Medical College, Kalaburagi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AJIM.AJIM_7_19

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  Abstract 

Tuberculous arteritis of the aorta is an uncommon condition usually secondary to the dissemination of Mycobacterium tuberculosis infection from the mediastinum and/or lung to the adjacent aorta; this may mimic Takayasu's arteritis. Aortoarteritis is an inflammatory condition of the aorta, which has been rarely reported due to tuberculous infection. We are presenting a case of 28-year-old young female of abdominal aortoarteritis along with tuberculosis (TB). Patient was treated with anti-TB therapy and steroids.

Keywords: Infectious vasculitis, large vessel vasculitis, tubercular aorto arteritis


How to cite this article:
Kamath A, Biradar S. A rare case of tuberculosis along with abdominal aorto arteritis in young women. APIK J Int Med 2020;8:19-21

How to cite this URL:
Kamath A, Biradar S. A rare case of tuberculosis along with abdominal aorto arteritis in young women. APIK J Int Med [serial online] 2020 [cited 2020 Jan 21];8:19-21. Available from: http://www.ajim.in/text.asp?2020/8/1/19/275983




  Introduction Top


Aortoarteritis is a chronic inflammatory disorder of large elastic arteries usually affecting the aorta and its larger branches along with pulmonary arteries with an incidence of 0.01 cases/100,000 population per year.[1] It is more common in females, with a female-to-male ratio of 4:1 in India. It can be due to infectious and noninfectious causes, but aortoarteritis due to tuberculosis (TB) is a rare entity, as seen in 1% of cases of aortitis.[2] We report a case of tuberculosis along with abdominal aortoarteritis in a 28-year-old young women.


  Case Report Top


A 28-year-old female presented with fever, chills, and dry cough with no diurnal and positional variation since February 2018, then patient had treatment at local hospital where she was residing, but still her symptoms persisted and later she was started on anti-tubercular drugs from April 2018 for 6 months as her sputum was positive for Mycobacterium tuberculosis (MTB) genexpert, further after treatment with anti-tuberculosis therapy (ATT) drugs cough and fever symptoms improved. She was diagnosed with hypertensive since October 2018 and was not on treatment. She also complained of headache which was holocranial since September 2018. She also gave a history of bilateral thigh and calf muscle pain on walking for 100 m claudication. There was no history of palpitation or chest pain or breathlessness.

There was no family history of the same illness or TB in her family members.

General physical examination

The patient is underweight (body weight was 42 kg, height 155 cm, and body mass index = 17.5). During examination, she was afebrile, upper limb pulsations were normal with absent pulsations in both lower limbs. Carotid pulsations were present bilaterally. Her pulse rate was 86 bpm regular, good volume, normal vessel wall with blood pressure (BP) measured in all the four limbs and was recorded as the following: BP in the right upper limb 160/90 mmHg, left upper limb 200/100 mmHg were as in both lower limbs, it was 70 systolic.

Cardiac examination showed normal heart sounds at the apex of the heart and at the base and bruit at the right carotid was present. Other systemic examinations were within the normal limits. Chest and abdomen examinations revealed no abnormal findings.

Laboratory investigations

Hemoglobin was 11.95 g/dl, erythrocyte sedimentation rate (ESR) was 90 mm in the 1st h, C-reactive protein (CRP) was 3 mg/dl, and total white blood cells and platelet count were normal. All tests for autoimmune antibodies were negative, her liver function test, renal function test, thyroid function test, and urine analysis were all within the normal limits.

Genexpert for MTB sputum was positive without rifampicin resistance. Electrocardiograph showed sinus rhythm.

Ultrasonograph abdomen was normal.

Bilateral lower limb Doppler showed dampened flow seen in abdominal aorta bilateral common iliac, external iliac, common femoral, popliteal, tibial and dorsalispedis arteries.

Echocardiography showed normal left ventricular function with left ventricular hypertrophy and flow acceleration in retrocardiac thoracic aorta measured out abdominal aorta tracing suggestive of aorto arteritis.

Computed tomography (CT) thorax showed features of chronic obstructive pulmonary disease and partially healed Koch's in the right upper lobe with traction bronchiectasis with the endobronchial spread of infection.

CT angiogram showed narrowing of the thoracic aorta with dissection of the right brachiocephalic trunk. CT Scan showing in [Figure 1], [Figure 2], [Figure 3], [Figure 4].
Figure 1: Aortogram showing narrowing of thoracic thoracic aorta

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Figure 2: Axial section showing dissection of aorta

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Figure 3: Axial section showing calcification of aorta

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Figure 4: Coronal section showing narrowing of aorta

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  Discussion Top


Aortoarteritis is a disease characterized by pan-arteritis along with extensive intimal proliferation, inflammation of media and adventitia, followed by marked fibrous scarring which occurs due to noninfectious or rheumatic cause such as Takayasu's arteritis (TA) or infectious causes such as syphilis,  Salmonella More Details, and TB.[1] Aortoarteritis due to TB involves the aortic wall by direct extension from contagious lesions such as infected lymph nodes, empyema, and pericarditis or by hematogeneous/lymphatic spread from primary lesions and is indicative of disseminated TB and presents with the erosion of the arterial wall with the formation of false and true mycotic aneurysms. It usually develops at the distal aortic arch and the descending aorta that is close to specific groups of mediastinal lymph nodes but might also develop in the ascending aorta. Previous studies suggest that cross-reaction between Mycobacterium and human heat shock protein might have a key role.[3] It has also been speculated that M. tuberculosis can be the triggering factor through its production of superantigens, the suggested role of which is thought to be through the stimulation of autoreactive T-cells that induce vascular damage.

Our patient showed marked ESR elevation, which had been estimated to be 70 mm in the 1st h and CRP 3 mg/l, but once anti-TB drugs were started our patients symptoms started regressing and at the end of treatment of 6 months of anti-tubercular treatment her ESR was 10 mm in the 1st h.

The symptoms of aortoarteritis are due to obliterate and inflammatory effects of the lesion.[1] Dissection, rupture, fistula, perforation, and bleeding of the aneurysms are important complications of tuberculous aortitis. The diagnosis of tuberculous aortoarteritis is difficult as it is rare and mimics TA and thus is a diagnosis of exclusion and ATT along with high-dose steroids should be instead early as the recommended treatment as done on our patient.


  Conclusion Top


We conclude that aortoarteritis as a large elastic artery disease should be considered in patients with tuberculosis; even though it is most commonly mimics like TA, in India, we still would like to consider tuberculosis as the foremost cause for the same. Since after the treatment with ATT patient has responded well and the parameters such as ESR and general condition of the patient has improved, and hence, we conclude that in our study aortoarteritis is due to tuberculosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Goyal A, Shah I. Aortoarteritis with tuberculosis. J Family Med Prim Care 2017;6:153-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Panja M, Kar AK, Dutta AL, Chhetri M, Kumar S, Panja S. Cardiac involvement in non-specific aorto-arteritis. Int J Cardiol 1992;34:289-95.  Back to cited text no. 2
    
3.
Al-Aghbari K, Al-Motarreb A, Askar F. Takayasu's arteritis associated with tuberculosis in a young Yemeni woman. Heart Views 2010;11:117-20.  Back to cited text no. 3
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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