Complex Management of an Infectious Aortic Pseudoaneurysm Secondary to Disseminated Tuberculosis in a Patient with Systemic Lupus Erythematosus and End-Stage Renal Disease: A Case Report.

Abstract

Infectious aortic pseudoaneurysm secondary to disseminated tuberculosis is rare and potentially fatal, particularly in immunocompromised patients. We report a 37-year-old female patient with systemic lupus erythematosus and end-stage renal disease on immunosuppressive therapy and hemodialysis who presented with post-dialysis fever. Computed tomography angiography (CTA) revealed a descending thoracic aortic pseudoaneurysm. During hospitalization, she developed persistent fever, abdominal pain, and lower-extremity purpura. Urgent thoracic endovascular aortic repair (TEVAR) was performed using a 24×100 mm single thoracic stent-graft. Post-TEVAR CTA demonstrated a persistent endoleak, raising concern for a distal type Ib versus type III endoleak; therefore, left thoracotomy was performed, and a type III endoleak was confirmed intraoperatively. Tuberculous aortitis was confirmed by GeneXpert (Cepheid) analysis of the aortic tissue. Renal-adjusted antitubercular therapy was administered with favorable clinical and imaging outcomes. This case highlights the importance of early recognition and multidisciplinary management of tuberculous aortitis in high-risk patients.