A rare case of COVID-19 associated aortitis

ABSTRACT

Background: There has been a myriad of vascular manifestations associated with the coronavirus disease 2019 (COVID-19) pandemic, including reports of associated small- and medium-vessel vasculitis. However, there are limited reports of large vessel vasculitis, specifically aortitis, related to the COVID-19 infection. Case presentation A 62-year-old female with history notable for peripheral artery disease, chronic obstructive pulmonary disease, hypertension, and hyperlipidemia presented for evaluation of abdominal pain. She was hospitalized two weeks prior with a COVID-19 infection causing respiratory failure. At presentation, she endorsed one week of progressive lower abdominal pain with anorexia. Vitals were notable for a blood pressure of 185/93 mmHg and heart rate of 94. Labs were notable for white blood cell count 8.1, CRP 85.4, and ESR of 96. A CT abdomen/pelvis with IV contrast demonstrated circumferential wall thickening of the infrarenal aorta with surrounding inflammatory stranding, suggestive of aortitis (Panel A). Additional evaluation included negative blood cultures, non-reactive RPR, normal IgG subclass 4, negative ANA screen, negative myeloperoxidase and proteinase-3 antibodies, and negative cryoglobulin. Given her recent COVID-19 infection, it was felt that her aortitis was COVID-19 related. For this, the patient was initiated on prednisone 60mg daily after her negative infectious work up with subsequent resolution of her abdominal pain. Repeat imaging and labs at 2 weeks demonstrated resolution of aortic findings (Panel B) and normalization of inflammatory markers. Her prednisone was tapered over a 6-week course without recurrence of symptoms. Conclusion(s) Aortitis should be recognized as a potential complication related to COVID-19 infections. While aortitis is associated with significant morbidity and mortality, early initiation of corticosteroids can lead to favorable outcomes.