Acute aortic dissection as a cause of shaking chills.

An 81‐year‐old woman was brought to the emergency department with acute onset of shaking chills. She had no upper respiratory tract symptoms and chest, back, or abdominal pains before the arrival to the hospital. Her only regular medication was a nifedipine for hypertension.

On examination, she was ill‐appearing and had shaking chills. The blood pressure was 170/87 mmHg in the right upper extremity and 165/81 mmHg in the left upper extremity, pulse of 68 per minute, respiratory rate of 28 per minute. The temperature was 36.3 degrees at the time of arrival, and it was elevated to 38.5 degrees 6 hours later. The remainder of other physical examinations was normal. Laboratory tests revealed white‐cell count of 46×108/L, neutrophils of 27×108/L, hemoglobin of 10.8 g/dL, platelets of 16.9×109/μL, D‐dimer of 5.6 μg/mL, and C‐reactive protein of 0.12 mg/dL. Urine test was normal. ECG was unremarkable. Chest X‐ray revealed the widening of the mediastinum (9‐cm size of horizontal diameter).

The patient received physical examination from top to bottom, blood and urine tests, and 2 sets of blood cultures, urine culture in the emergency department. Non‐contrast and contrast CT scan imaging was obtained, revealing aortic dissection of Stanford type A (Figures 1 and 2). The CT scan showed no findings of other abnormality. In about two hours after the visit, the shaking chills stopped but she developed chest pain. She and her family did not want the surgery because the risk of surgery at her age was considered. The patient received conservative medical treatment with the antihypertensive agent, and she was discharged after her symptom was resolved and the blood pressure was controlled. Blood cultures grew no organisms.

Figure 1

Non‐contrast CT revealed aortic dissection of Stanford type A

Figure 2

Contrast CT revealed clearer aortic dissection of Stanford type A

Fever is one of rare symptoms of acute aortic dissection (AAD),1 which may be painless during the initial phase. Inflammatory response to a dissociative aortic wall may lead to fever. Impending rupture of dissecting aortic aneurysm, as well as the destruction and of the aortic dissection, may cause a fever caused by tissue, thrombus formation, which occurs release of cytokines. Painless AAD is more common in the elderly and in those with Stanford type A, and it may be related to higher mortality.2 Shaking chills are usually considered as a symptom of sepsis but can be caused by ADD as in our patient. This case illustrates that AAD should be considered in patients with unexplained fever or shaking chills.

CONFLICT OF INTEREST

The authors have stated explicitly that there are no conflicts of interest in connection with this article.