title: Ascending aortic aneurysm caused by Mycobacterium tuberculosis.
abstract: BACKGROUND
  Tuberculous aortitis is an unusual presentation of a common disease in Sri Lanka. There were no reported cases of tuberculous aortitis from Sri Lanka. Here we report a case of a 40-year-old woman who developed an ascending aortic aneurysm with severe aortic regurgitation caused by Mycobacterium tuberculosis.
  
  
  METHODS
  A 40-year-old Sri Lankan female who presented with exertional breathlessness (NYHA II) and weight loss for 4 weeks duration was found to have collapsing pulse and early diastolic murmur at left sternal edge. Transthoracic and transesophageal echocardiogram showed ascending aortic aneurysm with severe aortic regurgitation. Computed tomographic aortography confirmed the diagnosis of aneurysmal dilatation of the ascending aorta. She underwent successful aortic valve replacement and aortic root replacement. The final diagnosis of tuberculous aortitis was made on the basis of macroscopic appearance of inflammation and microscopic confirmation of caseating granuloma. She made a good clinical recovery with category 1 antituberculous chemotherapy.
  
  
  CONCLUSIONS
  Although most cases of aortitis are non-infectious in Sri Lanka, an infectious etiology must be considered in the differential diagnosis because therapeutic approaches differ widely. Tuberculous aortitis may be under diagnosed in Sri Lanka, a country with intermediate tuberculosis burden, as the histological or microbiological diagnosis is not possible in most cases. The clinical and radiological diagnostic criteria for tuberculous aortitis need to be set out in case of aneurysmal aortic disease in the absence of apparent etiology.
authors.affiliation: Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Welisara, Sri Lanka. mailtoupul@gmail.com.
authors.forename: Upul
authors.initials: U
authors.lastname: Pathirana
authors.affiliation: Department of Respiratory Medicine, National Hospital for Respiratory Diseases, Welisara, Sri Lanka. kularatnesaman@yahoo.co.in.
authors.forename: Saman
authors.initials: S
authors.lastname: Kularatne
authors.affiliation: Department of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka. suneth871@gmail.com.
authors.forename: Suneth
authors.initials: S
authors.lastname: Karunaratne
authors.affiliation: Department of Cardiothoracic Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka. gaminiranasinghe@hotmail.com.
authors.forename: Gamini
authors.initials: G
authors.lastname: Ranasinghe
authors.affiliation: Department of Pathology, National Hospital of Sri Lanka, Colombo, Sri Lanka. janakiefernando@gmail.com.
authors.forename: Janakie
authors.initials: J
authors.lastname: Fernando
mesh_terms: D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D001011:Aorta / Q000187:drug effects / Q000382:microbiology* / Q000528:radiation effects; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D001025:Aortitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D001027:Aortography; D017548:Echocardiography, Transesophageal; D005260:Female; D006099:Granuloma / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D006350:Heart Valve Prosthesis; D054884:Host-Pathogen Interactions / Q000187:drug effects; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000502:physiology*; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000904:Antibiotics, Antitubercular