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Aortic Dissection in c-ANCA-Associated Vasculitis: A Case Report and Literature Review
Sidhartha G Senapati1, Joel Shah1, Lakshmi Kattamuri1
1Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA.
Cureus
|June 19, 2025
Summary
Cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA)-associated vasculitis rarely involves the aorta. This case details a Stanford type A aortic dissection in a patient with c-ANCA vasculitis, emphasizing early imaging and adaptable treatment.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Vascular Surgery
Background:
- Cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA)-associated vasculitis typically affects small and medium-sized vessels.
- Aortic involvement, including aortitis and dissection, is an uncommon complication of systemic vasculitis.
- Early recognition and management are crucial for improving outcomes in vasculitis patients.
Observation:
- A male patient in his 50s with hypertension presented with acute chest pain and shortness of breath.
- Initial CT revealed thoracic aortic thickening, leading to suspected vasculitis and initiation of high-dose steroids.
- Autoimmune testing confirmed elevated c-ANCA and anti-proteinase 3 antibodies.
Findings:
- A follow-up CT angiography identified a Stanford type A aortic dissection extending from the thoracic to the abdominal aorta.
- The dissection involved critical mesenteric arteries, necessitating urgent surgical repair.
- The patient's presentation mimicked initial vasculitis but revealed a life-threatening aortic dissection.
Implications:
- This case underscores the rare but severe risk of aortic dissection in c-ANCA-associated vasculitis.
- Serial imaging is vital for detecting major vascular complications early in vasculitis patients.
- Flexible treatment strategies, including timely surgical intervention, are essential for managing complex cases.
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