A Case of Tuberculous Aortitis

Abstract

Tuberculosis Aortitis (TA) is a rare phenomenon. A 20-year-old female presented with myalgia and arthralgia. Pulse was high volume, wide pulse pressure, forceful and shifted apex beat, dancing carotids, diastolic murmur heard over the aortic area were detected. Echocardiogram showed dilated aortic root with bilobed irregular contrast filled collection from right coronary cusp indicating right sinus of Valsalva pseudoaneurysm(SoVA) and severe aortic regurgitation. CT scan of chest and abdomen revealed mediastinal lymph nodes, abdominal and iliac nodes. Lymphnode biopsy was planned, but patient didn’t turn up. At 22 years age she presented with abdominal pain, vomiting and haemorrhagic shock. Echocardiogram showed right coronary cusp  aneurysm rupture  into interventricular septum, and severe aortic regurgitation. CT Aortogram revealed dissection flap in Abdominal Aorta with partial eccentric thrombus and gross ascites. Infection work up for aneurysm revealed that her Mantoux test and interferon gamma release assay (IGRA) were strong positive. She was started on Anti tuberculosis therapy (ATT), steroids and is being taken up for SoVA repair. Management of TA includes steroids, ATT and surgical intervention when required.