Disseminated tuberculosis in an immunocompetent patient

Area of Science:

• Infectious Diseases
• Cardiovascular Medicine
• Radiology

Background:

• Miliary tuberculosis is a disseminated form of Mycobacterium tuberculosis infection.
• Aortic aneurysms are rare complications of tuberculosis, often linked to contiguous spread.
• Mycotic aneurysms typically result from bacterial seeding of the aortic wall.

Observation:

• A case of tuberculous mycotic aneurysm in the aorta is presented in a patient with miliary tuberculosis.
• The patient had no cellular immunodeficiency or other common risk factors for infection.
• Mycobacterium tuberculosis was eventually identified in lung, lymph nodes, and gastric lavage.

Findings:

• The patient received anti-tubercular therapy and endovascular stenting.
• Diagnosis was confirmed despite initial lack of microbiological evidence.
• This case highlights an unusual presentation of disseminated tuberculosis.

Implications:

• Clinicians should consider Mycobacterium tuberculosis as a cause of mycotic abdominal aortic aneurysms, even with negative cultures.
• The presence of a contiguous tubercular focus should raise suspicion for aortic involvement.
• Prompt diagnosis and management are vital for improving outcomes in tuberculous mycotic aneurysms.