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Aortitis requiring aortic repair associated with glaucoma, thyroiditis, glaucoma, and neuropathy: case report.

Stöllberger C, Avanzini M, Hanafin A, Sanani R, Wieselthaler G, Wick N, Bayer G, Mölzer G, Finsterer J - J Cardiothorac Surg (2011)

Bottom Line: Aortitis may be due to infectious and non-infectious causes.We observed aortitis, associated with glaucoma, thyroiditis, pericarditis, pleural effusion and neuropathy in a 63-years old woman.Since all other possible causes were excluded, an immunological mechanism of the aortitis is suspected and possible triggering factors are discussed.

View Article: PubMed Central - HTML - PubMed

Affiliation: 2nd Medical department, Krankenanstalt Rudolfstiftung, Österreich, Austria. claudia.stoellberger@chello.at

ABSTRACT
Aortitis may be due to infectious and non-infectious causes. We observed aortitis, associated with glaucoma, thyroiditis, pericarditis, pleural effusion and neuropathy in a 63-years old woman. Despite antibiotic therapy, inflammatory signs persisted and resolved only after initiation of glucocorticoid therapy. Increasing aortic ectasia necessitated resection of the ascending aorta and implantation of a Vascutek 30 mm prosthesis. Histologically a granulomatous aortitis was diagnosed. Since all other possible causes were excluded, an immunological mechanism of the aortitis is suspected and possible triggering factors are discussed.

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Thoracic CT from August 2004 - Thoracic CT from August 2004 showing an increase in the thickness of the aortic wall.
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Figure 2: Thoracic CT from August 2004 - Thoracic CT from August 2004 showing an increase in the thickness of the aortic wall.

Mentions: Two months later, she was again hospitalized because of chest pain, fever and dyspnoea. Echocardiography and chest CT detected 3 mm pericardial effusion and an increase in the thickness of the aortic wall from 10 to 16 mm (Figure 2). Since there were no signs of aortic dissection or an intramural haematoma, aortitis was assumed. Arterial hypertension necessitated pharmacological therapy. Cephazolin, and later piperacillin-tazobactam were started, without any effect on the elevated CRP levels (20.5 mg/dl). Eventually, bilateral pleural effusions necessitated drainage. The pleural fluid showed a glucose content of 71 mg/dl (⊥ < 60), total protein of 4.0 g/dl (⊥ 0.3 - 4.1) and a LDH activity of 302 U/l (⊥ < 200), but no growth of bacteria or Mycobacterium tuberculosis. Cytological investigation of the pleural fluid revealed inflammatory cells comprising granulocytes, lymphocytes, nuclear fragmented macrophages and degenerated mesothelial cells with cytoplasmatic inclusions. A biopsy of the left temporal artery revealed no signs of inflammation. Clinical and electrophysiological neurological investigations showed sensorimotor polyneuropathy of both lower limbs and she also displayed symptoms of depression.


Aortitis requiring aortic repair associated with glaucoma, thyroiditis, glaucoma, and neuropathy: case report.

Stöllberger C, Avanzini M, Hanafin A, Sanani R, Wieselthaler G, Wick N, Bayer G, Mölzer G, Finsterer J - J Cardiothorac Surg (2011)

Thoracic CT from August 2004 - Thoracic CT from August 2004 showing an increase in the thickness of the aortic wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3113932&req=5

Figure 2: Thoracic CT from August 2004 - Thoracic CT from August 2004 showing an increase in the thickness of the aortic wall.
Mentions: Two months later, she was again hospitalized because of chest pain, fever and dyspnoea. Echocardiography and chest CT detected 3 mm pericardial effusion and an increase in the thickness of the aortic wall from 10 to 16 mm (Figure 2). Since there were no signs of aortic dissection or an intramural haematoma, aortitis was assumed. Arterial hypertension necessitated pharmacological therapy. Cephazolin, and later piperacillin-tazobactam were started, without any effect on the elevated CRP levels (20.5 mg/dl). Eventually, bilateral pleural effusions necessitated drainage. The pleural fluid showed a glucose content of 71 mg/dl (⊥ < 60), total protein of 4.0 g/dl (⊥ 0.3 - 4.1) and a LDH activity of 302 U/l (⊥ < 200), but no growth of bacteria or Mycobacterium tuberculosis. Cytological investigation of the pleural fluid revealed inflammatory cells comprising granulocytes, lymphocytes, nuclear fragmented macrophages and degenerated mesothelial cells with cytoplasmatic inclusions. A biopsy of the left temporal artery revealed no signs of inflammation. Clinical and electrophysiological neurological investigations showed sensorimotor polyneuropathy of both lower limbs and she also displayed symptoms of depression.

Bottom Line: Aortitis may be due to infectious and non-infectious causes.We observed aortitis, associated with glaucoma, thyroiditis, pericarditis, pleural effusion and neuropathy in a 63-years old woman.Since all other possible causes were excluded, an immunological mechanism of the aortitis is suspected and possible triggering factors are discussed.

View Article: PubMed Central - HTML - PubMed

Affiliation: 2nd Medical department, Krankenanstalt Rudolfstiftung, Österreich, Austria. claudia.stoellberger@chello.at

ABSTRACT
Aortitis may be due to infectious and non-infectious causes. We observed aortitis, associated with glaucoma, thyroiditis, pericarditis, pleural effusion and neuropathy in a 63-years old woman. Despite antibiotic therapy, inflammatory signs persisted and resolved only after initiation of glucocorticoid therapy. Increasing aortic ectasia necessitated resection of the ascending aorta and implantation of a Vascutek 30 mm prosthesis. Histologically a granulomatous aortitis was diagnosed. Since all other possible causes were excluded, an immunological mechanism of the aortitis is suspected and possible triggering factors are discussed.

Show MeSH
Related in: MedlinePlus