Granulomas are non-specific findings in histopathology. While there are other more common aortic vasculitides presenting with granulomas, tuberculosis is an important differential in countries where tuberculosis is endemic. Tuberculous (TB) aortitis should be ruled out because the usual treatment of other granulomatous aortic vasculitides
requires steroids and the course of TB is prolonged with complications in a patient erroneously given steroid therapy.
This is a case report describing a patient diagnosed with tuberculous aortitis after being referred to the Philippine Heart Center for urgent repair of a thoracic aortic aneurysm with aortic root dissection. Post-operatively, the patient presented with recurrent episodes of fever despite empiric antibiotic therapy for urinary tract infection and pneumonia. Histopathology of the aorta later revealed cystic medial degeneration with dissection, and chronic granulomatous infection. The patient tested positively with TB interferon gamma release assay.
While TB aortitis with acute aortic dissection has no established management guidelines, once diagnosed, its treatment includes well supervised anti-Koch's oral regimens after emergent aortic repair and regular surveillance CT aortograms. With early treatment, prognosis is generally good. However, significant morbidity and mortality is associated with advanced age, thoracic location of aneurysm, and aortic rupture.