Massive Hemoptysis Revealing Rasmussen's Aneurysm in Active Pulmonary Tuberculosis: A Report of a Fatal Case

Rasmussen's aneurysm is a rare but potentially fatal vascular complication of pulmonary tuberculosis and an uncommon cause of massive hemoptysis. A 27-year-old female with no significant past medical history was admitted for a seven-month history of productive cough, intermittent mild hemoptysis, fever, night sweats, and marked asthenia. Chest computed tomography revealed multiple bilateral cavitary lesions and a focal dilatation of a segmental pulmonary artery within a left basal alveolar consolidation, consistent with Rasmussen's aneurysm. Sputum Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay (Cepheid, Sunnyvale, CA) confirmed drug-susceptible pulmonary tuberculosis. Laboratory testing showed microcytic hypochromic anemia with a hemoglobin level of 7.6 g/dL. The patient received intravenous hemostatic therapy and urgent transfusion of two units of packed red blood cells. Endovascular embolization was planned within 24 hours; however, she died shortly afterward from sudden massive hemoptysis. This case highlights that Rasmussen's aneurysm may complicate active pulmonary tuberculosis at initial presentation, particularly in the setting of delayed diagnosis, and underscores the need for rapid vascular imaging and urgent multidisciplinary management in any patient with cavitary tuberculosis and hemoptysis.