Laure Delaval1, Tiphaine Goulenok1, Paul Achouh2, David Saadoun3, Julien Gaudric4, Quentin Pellenc5, Jean-Emmanuel Kahn6, Nicoletta Pasi7, Damien van Gysel8, Patrick Bruneval9, Thomas Papo10, Karim Sacre11. 1. Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France. 2. Département de Chirurgie Cardiovasculaire, Hôpital Européen Georges Pompidou, Université Paris Descartes, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France. 3. Département de Médecine Interne, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, Paris, France. 4. Département de Chirurgie Vasculaire, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, Paris, France. 5. Département de Chirurgie Vasculaire, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France. 6. Département de Médecine Interne, Hôpital Foch, Suresnes, France. 7. Département de Radiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France. 8. Département d'Epidémiologie, Biostatistiques et Recherche Clinique, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France. 9. Département de Pathologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France. 10. Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodeling in Renal and Respiratory Diseases), Paris, France. 11. Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodeling in Renal and Respiratory Diseases), Paris, France. Electronic address: karim.sacre@aphp.fr.
Abstract
OBJECTIVE: Aortitis is an exceedingly rare manifestation of tuberculosis. We describe 11 patients with tuberculous aortitis (TA). METHODS: Multicenter medical charts of patients hospitalized between 2003 and 2015 with TA in Paris, France, were reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. TA was considered when aortitis was diagnosed in a patient with active tuberculosis. RESULTS: Eleven patients (8 women; median age, 44.6 years) with TA were identified during this 12-year period. No patient had human immunodeficiency virus infection. Tuberculosis was active in all cases, with a median delay of 18 months between the first symptoms and diagnosis. At disease onset, vascular signs were mainly claudication, asymmetric blood pressure, and diminished distal pulses. Constitutional symptoms or extravascular signs were present in all patients at some point. Aortic pseudoaneurysm was the most frequent lesion, but three patients had isolated inflammatory aortic stenosis. TA appeared as extension from a contiguous infection in only three cases. Tuberculosis was considered because of clinical features, tuberculin skin or QuantiFERON-TB Gold (Quest Diagnostics, Madison, NJ) test results, pathologic findings, and improvement on antituberculosis therapy. A definite Mycobacterium tuberculosis identification was made in only three cases. All patients received antituberculosis therapy for 6 to 12 months. Surgery including Bentall procedures, aortic bypass, and open abdominal aneurysm repair was performed at diagnosis in eight patients. Seven patients received steroids as an adjunct therapy. All patients clinically improved under treatment. No patients died for a median follow-up duration of 4 years. CONCLUSIONS: TA may result in aneurysms contiguous to regional adenitis but also in isolated inflammatory aortic stenosis. Steroids may be associated with antituberculosis therapy for inflammatory stenotic lesions. Surgery is indicated for aneurysms and in case of worsening stenotic lesions despite anti-inflammatory drugs. No patient died after such combined treatment strategy.
OBJECTIVE:Aortitis is an exceedingly rare manifestation of tuberculosis. We describe 11 patients with tuberculous aortitis (TA). METHODS: Multicenter medical charts of patients hospitalized between 2003 and 2015 with TA in Paris, France, were reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. TA was considered when aortitis was diagnosed in a patient with active tuberculosis. RESULTS: Eleven patients (8 women; median age, 44.6 years) with TA were identified during this 12-year period. No patient had human immunodeficiency virus infection. Tuberculosis was active in all cases, with a median delay of 18 months between the first symptoms and diagnosis. At disease onset, vascular signs were mainly claudication, asymmetric blood pressure, and diminished distal pulses. Constitutional symptoms or extravascular signs were present in all patients at some point. Aortic pseudoaneurysm was the most frequent lesion, but three patients had isolated inflammatory aortic stenosis. TA appeared as extension from a contiguous infection in only three cases. Tuberculosis was considered because of clinical features, tuberculin skin or QuantiFERON-TB Gold (Quest Diagnostics, Madison, NJ) test results, pathologic findings, and improvement on antituberculosis therapy. A definite Mycobacterium tuberculosis identification was made in only three cases. All patients received antituberculosis therapy for 6 to 12 months. Surgery including Bentall procedures, aortic bypass, and open abdominal aneurysm repair was performed at diagnosis in eight patients. Seven patients received steroids as an adjunct therapy. All patients clinically improved under treatment. No patients died for a median follow-up duration of 4 years. CONCLUSIONS:TA may result in aneurysms contiguous to regional adenitis but also in isolated inflammatory aortic stenosis. Steroids may be associated with antituberculosis therapy for inflammatory stenotic lesions. Surgery is indicated for aneurysms and in case of worsening stenotic lesions despite anti-inflammatory drugs. No patient died after such combined treatment strategy.
Authors: Tetyana Shchetynska-Marinova; Klaus Amendt; Maliha Sadick; Michael Keese; Martin Sigl Journal: In Vivo Date: 2021 Jan-Feb Impact factor: 2.155
Authors: Louis Journeau; Marine de la Chapelle; Thomas Guimard; Yasmina Ferfar; David Saadoun; Isabelle Mahé; Yves Castier; Philippe Montravers; Xavier Lescure; Damien Van Gysel; Nathalie Asseray; Jean-Baptiste Lascarrou; Chan Ngohou; Yves-Marie Vandamme; Jérôme Connault; Patrick Desbordes de Cepoy; Julia Brochard; Yann Goueffic; Marc-Antoine Pistorius; David Boutoille; Olivier Espitia Journal: Medicine (Baltimore) Date: 2020-10-02 Impact factor: 1.817