A case of penetrating aortic ulcer complicated by tuberculosis: insights from the post-mortem

We report an autopsy case of a penetrating aortic ulcer caused by a combination of tuberculosis infection and background aortic atheroma. The patient was a male in his mid-60s with a past medical history of essential hypertension, prostate cancer, and cigarette smoking. He presented to his GP with significant unintentional weight loss/general malaise and a CT scan revealed a 4.5 cm ulcer in the arch of his aorta. Before vascular referral could be made, he was found dead at home with a left-sided haemothorax caused by rupture of his penetrating aortic ulcer. Histological examination showed granulomatous inflammation at the ulcer site with numerous acid-fast bacilli, consistent with Mycobacterium tuberculosis infection, and severe atheroma in the background aorta. This case highlights the rare interaction between atherosclerosis and tuberculosis in causing aortic ulceration.