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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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Histologic picture of the resected aortic wall - After formalin-fixation and paraffin embedding a 2 μm transversal full section of the ectatic aortal segment was stained with H&E according to a standard protocol. A dense and focally destructive inflammatory reaction that covered 75% of the wall thickness and predominated the media was observed. Specifically, focal necroses with neutrophilic granulocytes (asteriks, lower left) and bands of lymphocytic infiltrates with occasional multinuclear giant cells (arrow) could be identified. Magn.: 200 ×.
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Figure 3: Histologic picture of the resected aortic wall - After formalin-fixation and paraffin embedding a 2 μm transversal full section of the ectatic aortal segment was stained with H&E according to a standard protocol. A dense and focally destructive inflammatory reaction that covered 75% of the wall thickness and predominated the media was observed. Specifically, focal necroses with neutrophilic granulocytes (asteriks, lower left) and bands of lymphocytic infiltrates with occasional multinuclear giant cells (arrow) could be identified. Magn.: 200 ×.

Mentions: In November 2005 the diameter of the ascending aorta had increased to 55 mm, therefore the patient underwent resection of the aneurysm of the ascending aorta, implantation of a Vascutek 30 mm prosthesis and a thrombendarterectomy of the right subclavian artery. Histological examination of the resected aortic wall showed a granulomatous aortitis (Figure 3). Molecular genetic testing for Mycobacterium tuberculosis was negative. Prednisolone was stopped in January 2007. Since then, the patient is well, there are no clinical, biochemical, or haematological signs of inflammation, and she is currently managed with 100 mg metoprolol, 20 mg lisinopril and 30 mg mirtazapine. The IUD is still in place because it is impossible to remove it transvaginally.


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)

Histologic picture of the resected aortic wall - After formalin-fixation and paraffin embedding a 2 μm transversal full section of the ectatic aortal segment was stained with H&E according to a standard protocol. A dense and focally destructive inflammatory reaction that covered 75% of the wall thickness and predominated the media was observed. Specifically, focal necroses with neutrophilic granulocytes (asteriks, lower left) and bands of lymphocytic infiltrates with occasional multinuclear giant cells (arrow) could be identified. Magn.: 200 ×.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Histologic picture of the resected aortic wall - After formalin-fixation and paraffin embedding a 2 μm transversal full section of the ectatic aortal segment was stained with H&E according to a standard protocol. A dense and focally destructive inflammatory reaction that covered 75% of the wall thickness and predominated the media was observed. Specifically, focal necroses with neutrophilic granulocytes (asteriks, lower left) and bands of lymphocytic infiltrates with occasional multinuclear giant cells (arrow) could be identified. Magn.: 200 ×.
Mentions: In November 2005 the diameter of the ascending aorta had increased to 55 mm, therefore the patient underwent resection of the aneurysm of the ascending aorta, implantation of a Vascutek 30 mm prosthesis and a thrombendarterectomy of the right subclavian artery. Histological examination of the resected aortic wall showed a granulomatous aortitis (Figure 3). Molecular genetic testing for Mycobacterium tuberculosis was negative. Prednisolone was stopped in January 2007. Since then, the patient is well, there are no clinical, biochemical, or haematological signs of inflammation, and she is currently managed with 100 mg metoprolol, 20 mg lisinopril and 30 mg mirtazapine. The IUD is still in place because it is impossible to remove it transvaginally.

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