Miliary tuberculosis presenting as bilateral superficial femoral artery mycotic aneurysm in an immunocompetent patient

Abstract

Mycotic tuberculous aneurysm is extremely rare. The aorta is the main affected artery however; iliac and less commonly femoral arteries can also be affected. In 75% of the cases a contagious focus leads to infection through erosion of the vessel wall; on the other hand direct seeding of the blood vessel wall via the vasa vasorum may occur in 25%. In a large number of patients it may be a manifestation of miliary tuberculosis. In this case report we describe an immunocompetent patient who presented with bilateral superficial femoral artery aneurysms, followed by bilateral testicular swellings and inferior mesenteric artery aneurysm, as a presentation of military tuberculosis. Early diagnosis of such patients is essential for initiation of both medical and surgical treatment in order to avoid catastrophic outcome of rupture and bleeding.

Tuberculous Aortic Aneurysm - A Review

“…Currently published literature reported about 22 cases of bacillus Calmette-Guérin (BCG) spondylitis after intravesical therapy. Among them, only four cases showed a combination of mycotic aortic aneurysm and BCG spondylitis [ 17 , 20 - 22 ] .…”

“…The aneurysm could have been sterilized if the pre-existing lesion is taken in the aortic wall of vasa vasorum infected by M. tuberculosis [ 46 , 47 ] .…”

Spontaneous Transection of the Superficial Femoral Artery with Devastating Outcomes: A Case Report

“…Simultaneous, non-traumatic, infected pseudoaneurysms affecting bilateral SFAs, such as this case, have rarely been reported in the literature. Elzein et al [ 3 ] described such a presentation in a patient with miliary tuberculosis. In contrast, unilateral infected pseudoaneurysm of the SFA is relatively common, and Staphylococcus aureus , Salmonella spp., and E.coli have been described as causative organisms [ 4 - 6 ].…”

CT Imaging Manifestations of Tubercular Aortic Aneurysm

“…Thus, TB pseudoaneurysm often occurs in the thoracic and abdominal aorta [6]. Less frequently, femoral [20], iliac [21] and subclavian [14] arteries can also be affected. Most of the aneurysms were saccular (98%) [6].…”