Annals of Vascular Surgery - Brief Reports and Innovations (Dec 2021)
Abdominal aortic aneurysm as single presentation of isolated lymph node tuberculosis
Abstract
Introduction: Tuberculosis is a prevalent infection worldwide, especially in low-income countries. Its manifestations are diverse, and although pulmonary affection is the most common presentation, aortic involvement has been described. When present, such involvement can ultimately result in aortic aneurysm. Tuberculous aortic aneurysm (TAA) is a rare clinical entity with few cases described to date. We present a case of tuberculous lymphadenitis with pseudoaneurysm of the abdominal aorta in an otherwise healthy patient. Case description: A 24-year-old male patient from Punjab, India, living in Portugal for 3 months before seeking medical attention, presented at the emergency department with a 5-day history of lower quadrant abdominal pain, that worsened two days before. On physical examination, the patient was febrile and had infra-umbilical tenderness at abdominal palpation. Blood tests revealed microcytic anemia and elevated C-reactive protein. Abdominal ultrasound detected a mass adjacent to the lateral aspect of the distal abdominal aorta, further better characterized by computed tomography (CT) angiography as a saccular dilatation of the infra-renal aorta suggestive of a mycotic pseudoaneurysm.Transthoracic echocardiogram excluded endocarditis. The patient was admitted to the ward and started empiric broad spectrum antibiotics. A full body CT-scan showed a left supraclavicular lymph node with necrotic center, that was surgically excised and whose cultures grew Mycobacterium tuberculosis, with full susceptibility to first line tuberculostatic drugs. Surgery, with infra-renal aortic excision and aorto-aortic interposition with a silver-impregnated Dacron graft, was implemented along with anti-TB treatment. There are no reported complications at 6 months follow-up. Conclusion: TAA is a rare and potentially fatal disease that should be considered in diagnosis of mycotic aneurisms particularly in patients from high incidence setting. Such diagnosis requires exhaustive investigation, and its treatment can be complex, requiring a multidisciplinary approach. The combination of both a medical and surgical approaches is paramount for the successful treatment of such cases.
