title: New insights on tuberculous aortitis.
abstract: Aortitis is an exceedingly rare manifestation of tuberculosis. We describe 11 patients with tuberculous aortitis (TA).
  
  
  
  Multicenter medical charts of patients hospitalized between 2003 and 2015 with TA in Paris, France, were reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. TA was considered when aortitis was diagnosed in a patient with active tuberculosis.
  
  
  
  Eleven patients (8 women; median age, 44.6 years) with TA were identified during this 12-year period. No patient had human immunodeficiency virus infection. Tuberculosis was active in all cases, with a median delay of 18 months between the first symptoms and diagnosis. At disease onset, vascular signs were mainly claudication, asymmetric blood pressure, and diminished distal pulses. Constitutional symptoms or extravascular signs were present in all patients at some point. Aortic pseudoaneurysm was the most frequent lesion, but three patients had isolated inflammatory aortic stenosis. TA appeared as extension from a contiguous infection in only three cases. Tuberculosis was considered because of clinical features, tuberculin skin or QuantiFERON-TB Gold (Quest Diagnostics, Madison, NJ) test results, pathologic findings, and improvement on antituberculosis therapy. A definite Mycobacterium tuberculosis identification was made in only three cases. All patients received antituberculosis therapy for 6 to 12 months. Surgery including Bentall procedures, aortic bypass, and open abdominal aneurysm repair was performed at diagnosis in eight patients. Seven patients received steroids as an adjunct therapy. All patients clinically improved under treatment. No patients died for a median follow-up duration of 4 years.
  
  
  
  TA may result in aneurysms contiguous to regional adenitis but also in isolated inflammatory aortic stenosis. Steroids may be associated with antituberculosis therapy for inflammatory stenotic lesions. Surgery is indicated for aneurysms and in case of worsening stenotic lesions despite anti-inflammatory drugs. No patient died after such combined treatment strategy.
authors.affiliation: Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Delaval
authors.affiliation: Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Tiphaine
authors.initials: T
authors.lastname: Goulenok
authors.affiliation: Département de Chirurgie Cardiovasculaire, Hôpital Européen Georges Pompidou, Université Paris Descartes, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Achouh
authors.affiliation: Département de Médecine Interne, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Saadoun
authors.affiliation: Département de Chirurgie Vasculaire, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Gaudric
authors.affiliation: Département de Chirurgie Vasculaire, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Quentin
authors.initials: Q
authors.lastname: Pellenc
authors.affiliation: Département de Médecine Interne, Hôpital Foch, Suresnes, France.
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: Kahn
authors.affiliation: Département de Radiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Pasi
authors.affiliation: Département d'Epidémiologie, Biostatistiques et Recherche Clinique, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: van Gysel
authors.affiliation: Département de Pathologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Bruneval
authors.affiliation: Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodeling in Renal and Respiratory Diseases), Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Papo
authors.affiliation: Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1149, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodeling in Renal and Respiratory Diseases), Paris, France. Electronic address: karim.sacre@aphp.fr.
authors.forename: Karim
authors.initials: K
authors.lastname: Sacre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D000995:Antitubercular Agents / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D001025:Aortitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D001027:Aortography / Q000379:methods; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D001706:Biopsy; D000072226:Computed Tomography Angiography; D005260:Female; D005602:France; D006801:Humans; D059425:Interferon-gamma Release Tests; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014374:Tuberculin Test; D014381:Tuberculosis, Cardiovascular / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D014656:Vascular Surgical Procedures; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D013256:Steroids