[Fever of unknown origin and tuberculous aortitis]

Area of Science:

• Cardiology
• Infectious Diseases
• Pulmonology

Background:

• Silicosis is a chronic lung disease associated with an increased risk of infections.
• Fever of unknown origin (FUO) presents a diagnostic challenge, especially when recurrent or episodic.
• Infectious endocarditis is a serious condition often requiring prompt diagnosis and treatment.

Observation:

• A patient with silicosis experienced recurrent febrile episodes over three years, initially suspected as FUO and infectious endocarditis based on clinical signs and echocardiography.
• The patient developed severe aortic failure refractory to medical management, necessitating surgical intervention.
• Surgery revealed a tuberculous aortic root abscess, with an intact aortic valve, and echocardiography confirmed the abscess.

Findings:

• The aortic root abscess was identified as tuberculous in origin, a rare finding in this context.
• The case aligns with the criteria for recurrent or episodic FUO.
• This presentation suggests Mycobacterium tuberculosis as a previously unrecognized cause of episodic FUO.

Implications:

• Highlights the importance of considering tuberculosis in the differential diagnosis of FUO, particularly in patients with underlying lung diseases like silicosis.
• Underscores the potential for tuberculous abscesses to mimic other conditions such as infectious endocarditis, leading to diagnostic delays.
• Suggests a need for broader etiological investigations in recurrent FUO cases, including microbiological testing for Mycobacterium tuberculosis.