Tuberculous Aortitis with an Aortoduodenal Fistula Presenting as Recurrent Gastrointestinal Bleeding

Abstract

Tuberculous aortitis with a tuberculous mycotic aneurysm and an aortoduodenal fistula was diagnosed in a 38-year-old man with tuberculous cervical lymphadentitis and a 3-month history of recurrent gastrointestinal bleeding, in whom extensive investigation of the digestive tract had not revealed a bleeding lesion. Either by septic embolism or by direct extension from a neighboring focus, tuberculous infection can cause a mycotic aortic aneurysm with subsequent fistulation to the duodenum.

Tuberculous Aneurysm of the Supraceliac Aorta

“…8 In 1999 Long and colleagues 5 reviewed the world literature since 1945 and described 41 cases of tuberculous mycotic aneurysms of which 22 were treated with a combined medical and surgical approach. Fifteen additional cases treated in a likewise fashion have been reported since, 6,[9][10][11][12][13][14][15][16] including the present report. This entire group comprising 37 patients is summarized in Table I.…”

“…5 Clinically, tuberculous aortic involvement most commonly presents as an infected, or mycotic, pseudoaneurysm, although penetration into adjacent bowel resulting in an aortoenteric fistula has been reported. 6,7 Infrequently an aortic stenosis, rather than an aneurysm, has been attributed to tuberculous aortic involvement. 8 In 1999 Long and colleagues 5 reviewed the world literature since 1945 and described 41 cases of tuberculous mycotic aneurysms of which 22 were treated with a combined medical and surgical approach.…”

Takayasus Arteritis in Children: A Developing World Perspective

“…Reno-vascular stenosis due to other syndromic causes such as Williams Syndrome, Neurofibromatosis Type 1, Marfan' s Syndrome and Ehlers-Dahnlos Syndrome need to be considered before a diagnosis of TA can be made. In the developing world infectious causes of aortitis such as Treponema Pallidum, Staphylococcus, Shigella and Tuberculosis have to be considered [38][39][40].…”