TUBERCULOSIS AORTITIS OR TAKAYASU ARTERITIS?: CASE REPORT

Aortitis is an inflammatory condition of the aorta with infectious or non-infectious origin.Primary vasculitides like Takayasu arteritis (TAK) and giant cell arteritis are common non-infectious causes.Infectious aortitis can be due to bacteria, viruses, or fungi.Diagnosis is challenging due to non-specific symptoms, biomarkers, imaging, and limited histological examination.Tuberculous aortitis is rare, often resulting from contiguous infection (e.g., tuberculous lymphadenitis).It causes vessel wall erosion, forming true or false aneurysms, with pseudoaneurysm being the most common aortic involvement.Arterial wall thickening and vessel stenosis may occur, making differentiation from TAK difficult.Here, we report a case of tuberculosis with aortic involvement. CASE REPORTThe male patient, 35 years old, reports that 6 months before hospital admission, he started to experience intermittent fever, weight loss (approximately 10 kilograms), cough, progressive dyspnea, swelling of the lower limbs and nodular lesions on the legs suggestive of erythema nodosum.He was admitted to a reference hospital with congestive heart failure with a reduced ejection fraction of valvular etiology.At the time, the echocardiogram showed aneurysmal dilatation of the ascending aorta, moderate valve insufficiencies, and pseudoaneurysm in the sinus of Vassalva with fistulization into the left ventricle and extension through the mitralaortic intervalvar fibrosa, findings that were confirmed by coronary angiotomography.In the investigation, a small saccular image was also evidenced in the abdominal aorta at the origin of the superior mesenteric artery.Chest tomography showed no parenchymal alterations suggestive of tuberculosis (TB), sputum bacilloscopy and serology for syphilis were negative.The patient underwent cardiac surgery to correct the fistula, replacement of the ascending aorta with a Dacron tube, mechanical aortic and mitral valve replacement and tricuspid valve repair with a ring.Aortic biopsy was performed with evidence of non-specific lymphocytic aortitis without granulomas.In a second moment, endovascular treatment of a saccular aneurysm in the abdominal aorta was performed with prosthesis placement.Due to the suspicion of TAK, immunosuppressive treatment was started with prednisone 1mg/kg and methotrexate 15mg/week.However, after 2 months of treatment, the patient returns with a recurrence of fever and cough.A new infectious screening showed extensive pleural effusion in the left hemithorax.Due to the high suspicion of tuberculosis, the patient underwent pleuroscopy with biopsy, showing granuloma with caseous necrosis.Therefore, antituberculous therapy was started. CONCLUSIONTB is considered a possible trigger for TAK, and the differentiation between primary vasculitis and tuberculosis aortitis can be challenging.Early diagnosis is important, considering the high mortality rate associated with the rapid progression of tuberculous aneurysms and the risk of rupture.