A70-26 When Tuberculosis Strikes Twice: A Case of Rasmussen’s Aneurysm With Large-volume Hemoptysis

Abstract Rasmussen’s aneurysm is an inflammatory pseudoaneurysmal dilatation of a pulmonary artery that develops adjacent to or within a tuberculous cavity. This aneurysm results from chronic erosive inflammation, causing remodeling and progressive weakening of the arterial wall. Rasmussen’s aneurysm is a rare but potentially fatal complication of pulmonary tuberculosis (TB) due to massive hemoptysis. This case highlights a young female patient with pulmonary tuberculosis who developed a Rasmussen’s aneurysm, resulting in large-volume hemoptysis. A 20-year-old female, recently immigrated from South Africa, presented with fever and hemoptysis after a four-month history of persistent, productive cough. Initial chest x-ray showed multifocal pulmonary parenchymal opacities, primarily in the left lung. CT angiography of the chest showed multifocal parenchymal opacities with multiple cavitary lesions, most pronounced in the left lung. Sputum evaluation revealed multiple positive acid-fast bacilli (AFB) smears, and nucleic acid amplification testing (NAAT) confirmed Mycobacterium tuberculosis complex with no rifampin resistance on Xpert/RIF assay. Per infectious disease recommendations, the patient was initiated on rifampin, isoniazid, pyrazinamide, ethambutol (RIPE therapy), and pyridoxine supplementation. Despite adherence to therapy, she returned four days later with recurrent large-volume hemoptysis, expectorating 250 mL of frank blood and dark red blood clots during coughing episodes. Repeat CT angiography revealed a 0.7 cm arterial-enhancing focus within a left lower lobe cavity, consistent with Rasmussen’s aneurysm. She underwent successful selective coil embolization of the left lower lobe pulmonary artery pseudoaneurysm. The patient’s post-procedure course was complicated by airway clot clearance and transient fevers. The patient’s hemoptysis slowly resolved, and she was discharged on continued RIPE therapy under directly observed therapy (DOT) supervision through the county public health department. Differentiating the cause of hemoptysis in tuberculosis can be challenging due to multiple potential sources, including bronchiectasis, cavitary rupture, or vascular complications such as Rasmussen’s aneurysm. This case highlights the risk of vascular complications despite appropriate antibiotic therapy and additionally emphasizes the critical role of CT angiography for early recognition. Timely diagnosis of pseudoaneurysms allows for minimally invasive treatments like coil embolization to prevent massive and potentially fatal hemoptysis. This case also emphasizes the need for increased vigilance and close monitoring of TB patients, particularly those with cavitary disease. This patient’s recent immigration from a TB-endemic area underscores the importance of considering complex TB presentations and complications, even in low-incidence areas. Effective management requires multidisciplinary collaboration among infectious disease specialists, pulmonologists, and public health departments to ensure optimal treatment and infection control. This abstract is funded by: None