Title: Importance of early recognition and treatment of tuberculous aortitis

Yoshihiro Nakamura¹* , Kazuhiro Asada², Masashi Toyama³, Yoshiro Fujita¹

¹Department of Rheumatology, Chubu Rosai Hospital, 2-10-15, Komei-cho, Minato-ku, Nagoya, Aichi 455-8530, Japan

²Department of Respiratory Medicine, Shizuoka General Hospital, 4-27-1, Kita-Ando, Aoi, Shizuoka 420-8527, Japan

³Department of Cardiovascular Surgery, Toyohashi Municipal Hospital, 50 Hakkennishi, Aotake-cho, Toyohashi 441-8570, Japan

Authors’ E-mail addresses:

Yoshihiro Nakamura: nakamurashift@yahoo.co.jp

Kazuhiro Asada: kazuhiro-asada@i.shizuoka-pho.jp

Masashi Toyama: machapon@icloud.com

Yoshiro Fujita: hujitay@gmail.com

^* Correspondence to: Yoshihiro Nakamura

Department of Rheumatology, Chubu Rosai Hospital

2-10-15, Komei-cho, Minato-ku, Nagoya, Aichi 455-8530, Japan

Email: nakamurashift@yahoo.co.jp

Conflict of interest: The authors declared that there are no conflicts of interest in this work.

Patient consent: The patient has provided written informed consent for publication of his case details and the associated images.

Tuberculous aortitis is difficult to diagnose, but early treatment may limit the progression of tuberculosis aortitis, which may cause aortic stenosis or pseudoaneurysm formation if untreated. We provided antituberculous therapy on suspicion of tuberculous aortitis, despite the lack of definitive diagnosis, and obtained a favorable outcome.

Keywords: tuberculous aortitis, tuberculosis, aortitis; antituberculous therapy

A 22-year-old man from Nepal presented with a one-month history of fever and weight loss. He had no previous history of illness or medication use. Apart from an elevated serum C-reactive protein level (1.40 mg/dL), his physical examination and laboratory test results were unremarkable. Contrast-enhanced computed tomography (CT) showed a pericardial effusion, mediastinal lymphadenopathy, mild right lower-lobe lung consolidation, and ascending aortitis (Fig. 1a–c). The T-SPOT.TB test result was positive. Bronchoalveolar lavage and mediastinal lymph node biopsy were performed because of suspected active tuberculosis. Although the tuberculous culture and polymerase chain reaction tests for Mycobacterium tuberculosis were negative, we commenced treatment with isoniazid, rifampicin, pyrazinamide, ethambutol, and prednisolone (60 mg/day, tapered weekly). Two months later, the patient’s body temperature and weight normalized, so ethambutol, pyrazinamide, and prednisolone were discontinued. Isoniazid and rifampicin were continued for an additional 7 months. After 9 months of treatment, contrast-enhanced CT showed resolution of the aortitis (Fig. 1d), pericarditis, mediastinal lymphadenopathy, and lung consolidation. Early therapy may limit the progression of tuberculosis aortitis, which may cause aortic stenosis or pseudoaneurysm formation if untreated,¹ so we commenced drug therapy despite the lack of a definitive diagnosis, and obtained a favorable outcome.