Résumé
A 69-year-old woman, who had undergone a right nephrectomy for renal tuberculosis in her teens, was admitted with a low grade fever, anorexia and progressive dyspnea. Transthoracic echocardiography showed cardiac tamponade and chest CT revealed an enlarged ascending aorta. She was treated with pericardiocentesis. Specimens of pericardial effusion failed to demonstrate any acid-fast bacilli, but they did reveal a high level of adnosine deaminase (72 IU/<i>l</i>). A diagnosis of tuberculous pericarditis was considered, and antituberculous chemotherapy was started. However, he presented with severe back pain 32 days later and CT revealed type A acute aortic dissection. We therefore replaced the ascending aorta and aortic root. A histopathological examination of the ascending aorta revealed evidence of a granulomatous inflammatory reaction with Langhans giant cells. She thereafter received antituberculous chemotherapy with 4 drugs for 2 months, with continued rifampicin and isoniazid treatment. There was no evidence of any graft infection after 70 days.
Résumé
Two cases of tuberculous aortitis with aneurysm which ruptured are reported, together with a review of literature on the subjectThe aorta is involved in a tuberculous process either from a primary embolic enlodgement of tubercle bacilli on a damaged intima or vasa vasorum, or by infiltration of the adventitia from a peri-vascular focus of tuberculosisThere are no positive signs which can make possible the clinical diagnosis of the condition. The prognosis is grave and there has never been a report of successful surgical intervention. (Summary)