Aortitis Presenting as Fever of Unknown Origin

Yuan, Shi‐Min; Lin, Hong

doi:10.5761/atcs.ra.18-00136

Cited by 8 publications

(9 citation statements)

References 45 publications

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“…It is crucial to mention that differential diagnosis of aortitis is challenging, due to the non-specific constitutional symptoms of the patients [11,12]. is leads to diagnostic dilemmas and might lead to a series of unnecessary diagnostic workups.…”

Section: Discussionmentioning

confidence: 99%

“…Severe aortic regurgitation and dilatation of left ventricle was diagnosed 3 months earlier incidentally, and it was known that AS was diagnosed before four years. e most common causes of aortitis among the rheumatic diseases include giant cell arteritis, Takayasu arteritis, infective aortitis, Cogan syndrome (interstitial keratitis, iritis, conjunctival or subconjunctival hemorrhage, fever, and aortic insufficiency), and relapsing polychondritis and spondyloarthritis [11]. e underlying microorganisms of infective aortitis were most often Staphylococcus, Enterococcus, Streptococcus, and Salmonella species.…”

Section: Discussionmentioning

confidence: 99%

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Ankylosing Spondyloarthritis Resulting Severe Aortic Insufficiency and Aortitis: Exacerbation of Ankylosing Spondyloarthritis and Stenosis of the Main Left Coronary Artery after Mechanical Aortic Valve Implantation with Cardiopulmonary Bypass

Balčiūnaitė

Budrikis

Rumbinaitė

et al. 2020

Case Reports in Rheumatology

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Ankylosing spondyloarthritis (AS) is a chronic inflammatory rheumatic disease, strongly related to human leukocyte antigen (HLA)-B27. Cardiac involvement in AS manifests in 2 to 10% of patients as aortic insufficiency, aortitis, mitral valve fibrosis, or disturbance in the conduction of the heart. In this article, we present a case of a 49-year-old male patient with AS, who was referred to our medical institution for elective aortic valve surgery because of severe aortic regurgitation. The histological findings revealed fibrosing endocarditis of aortic valve and nonspecific aortitis of aortic root. Late postoperatively, we observed exacerbation of AS and narrowing of the main left coronary artery (LAD). Our case highlights the importance of proper treatment of AS before and after cardiac surgery. Furthermore, in this case, we suspect association between cardiopulmonary bypass, activity of AS, and coronary artery disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ankylosing Spondyloarthritis Resulting Severe Aortic Insufficiency and Aortitis: Exacerbation of Ankylosing Spondyloarthritis and Stenosis of the Main Left Coronary Artery after Mechanical Aortic Valve Implantation with Cardiopulmonary Bypass

Balčiūnaitė

Budrikis

Rumbinaitė

et al. 2020

Case Reports in Rheumatology

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“…The non-typhi Salmonella species are the most common cause. Currently, this entity is extremely rare in western countries, but mortality rate is over 20 % [3].…”

Section: Discussionmentioning

confidence: 99%

Large vessel vasculitis secondary to granulocyte-colony stimulating factor

Castillo

Loarce-Martos

Blanc-Molina

2020

Vasa

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Summary: Aortitis is a rare entity that may cause fever of unknown origin. This entity has a wide various etiologies, which main cause is rheumatologic, but not only. Iatrogenia has also been described, including chemotherapy and supporting treatment (like granulocyte-colony stimulating factor in oncological patients. The evidence in favour of this pharmacological link is growing. The differential diagnosis of fever, in febrile neutropenia setting, can be difficult to itemize.

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“…Aortitis is a rare diagnosis that requires a high level of suspicion [1] due to its presentation of nonspecific symptoms, including pain, fever, headache fatigue, tiredness, malaise, and arthralgias, and its multiplicity of aetiologies [2][3][4]. The etiology of aortitis can broadly be classified as infectious or non-infectious conditions, or idiopathic [1,5].…”

Section: Introductionmentioning

confidence: 99%

“…Therapeutic approaches used for non-infectious aortitis are various as antibiotics have little or no benefit in the treatment of non-infectious aortitis [5]. Furthermore, rarer differential diagnoses, such as aortitis secondary to neoplasms [6] must be taken into account as they require specific care that sometimes differs from the treatment of inflammatory aortitis [2]. This clinical case reports aortitis associated with arthritis that preceded the progression of early esophageal carcinoma.…”

Section: Introductionmentioning

confidence: 99%

Aortitis as a Harbinger of Esophageal Cancer

Lucas¹,

Alfaiate²,

Santos³

et al. 2021

Cureus

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Aortitis is a rare diagnosis that requires a high index of suspicion due to nonspecific symptoms and its multiplicity of etiologies.An 80-year-old man, independent in activities of daily living (ADLs), had three consecutive hospitalizations in three months for fever, general malaise, anorexia associated with arthritis of the hands and feet with the inability to walk. Inflammatory markers were increased without a focus of infection identified. Upper digestive endoscopy (UDE), colonoscopy, blood cultures, thoracoabdominal-pelvic CT and transthoracic (TT) echocardiogram were performed without changes, with discharge for consultation after demonstrating apyrexia. At the patient second hospitalization for fever and arthritis, a transesophageal echocardiogram was performed that showed the presence of multiple complex atherosclerotic plaques, with associated thrombi in all segments of the aorta with a suspicious mass of vegetation on the aorta. Thoracicabdominopelvic CT demonstrated calcified atheromatosis of the entire aorta with para-aortic nodes; MRI showed aortic thickening; and autoimmunity study was negative. Aortitis was the working diagnosis of possible infectious etiology and anticoagulation and antibiotic therapy were started. Fever recurred and a third admission led to a working diagnosis of inflammatory, non-infectious aortitis. The patient responded well to empiric corticosteroids.The patient followed up in consultation, remained asymptomatic under a low dose of corticosteroids with negative temporal artery biopsy. In the sixth month, he repeated UDE due to dysphagia, which showed the presence of esophageal neoformation with the histological diagnosis of squamous cell carcinoma, maintaining on the CT as alterations in the aorta. This is an unusual case of aortitis associated with arthritis with improvement after corticosteroids, which interestingly occurred before the progression of esophageal cancer. In hindsight, we think this may have been a large vessel paraneoplastic vasculitis that preceded the detection of esophageal squamous cell carcinoma.

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Aortitis Presenting as Fever of Unknown Origin

Cited by 8 publications

References 45 publications

Ankylosing Spondyloarthritis Resulting Severe Aortic Insufficiency and Aortitis: Exacerbation of Ankylosing Spondyloarthritis and Stenosis of the Main Left Coronary Artery after Mechanical Aortic Valve Implantation with Cardiopulmonary Bypass

Ankylosing Spondyloarthritis Resulting Severe Aortic Insufficiency and Aortitis: Exacerbation of Ankylosing Spondyloarthritis and Stenosis of the Main Left Coronary Artery after Mechanical Aortic Valve Implantation with Cardiopulmonary Bypass

Large vessel vasculitis secondary to granulocyte-colony stimulating factor

Aortitis as a Harbinger of Esophageal Cancer

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