Aortic aneurysm rupture as a rare complication of granulomatosis with polyangiitis: a case report

Abstract

IntroductionGranulomatosis with polyangiitis is characterized by systemic inflammation of medium and small blood vessels. Aortic involvement in granulomatosis with polyangiitis is extremely rare. As far as we know this is the first reported case of successful treatment in a patient with granulomatosis with polyangiitis complicated with aortic aneurysm rupture.Case presentationWe describe a case of granulomatosis with polyangiitis in a 38-year-old Japanese man who developed an aortic aneurysm rupture 22 years after disease onset. The patient was operated on and a J-graft was inserted. He recovered uneventfully.ConclusionRecommendations in regard to, and consideration of, aortic involvement should be kept in mind in the long-term careful follow up of granulomatosis with polyangiitis.

Vasculitis de grandes vasos en paciente con vasculitis ANCA (+): Caso clínico

“…En los casos publicados de asociación de vasculitis en vasos pequeños y grandes, la ocurrencia ha sido simultánea en la mayoría de los casos. Cuando fue metacrónica, el intervalo varió entre 6 meses y 22 años [5][6][7]9,14 . En esta paciente fue 9 años.…”

“…Otros autores han planteado que una vasculitis de las arterias retroperitoneales (periaortitis) invadiría la pared de la aorta 3,7 . Las biopsias efectuadas durante la reparación de aneurismas, revascularización o necropsias han revelado vasculitis de vasa vasorum y arterias retroperitoneales, inflamación, granulomas, rotura de las fibras elásticas de la media, necrosis fibrinoide y vasculitis necrotizante granulomatosa [2][3][4][5][6][7][8][9]19 . Si bien estos hallazgos son comunes con las vasculitis de grandes vasos clásicas, la necrosis parece ser un hecho distintivo las vasculitis ANCA(+) 3 .…”

“…Las vasculitis de vasos grandes, en cambio, no los tienen 1,2 . El compromiso de vasos grandes en las vasculitis de vasos pequeños ANCA(+) es raro [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Algunos autores consideran que es una coincidencia de dos patologías, otros creen que no lo es, sino que existe una patogénesis común 1,4,12 .…”

Eosinophilic aortitis with thoracic aortic aneurysm and rupture in a captive‐born owl monkey

“…In humans, it has been sporadically reported associated with a complex group of autoimmune large vessel vasculitides of unknown etiology. [1][2][3][4][5] In animals, eosinophilic aortitis without dissecting aneurysm has been reported in the mutant "mes" rat 6,7 and associated with parasitic migration in dogs, horses, and ruminants. 8 Aortic dissecting aneurysms are relatively common in owl monkeys and tamarins, but, to our knowledge, no eosinophilic aortitis has been reported in these species.…”

“…8 These diseases are part of a complex group of autoimmune vasculitides characterized by eosinophil infiltrates damaging small, medium, and, occasionally, large blood vessels. [1][2][3][4][5][17][18][19] Aotus azarae boliviensis persistently have one order of magnitude more eosinophils in the peripheral blood than Aotus nancymai, but the condition does not appear to cause any untoward clinical signs in this species. 13 On the other hand, a fatal case of hypereosinophilic syndrome with severe respiratory distress and multiple organ infiltration with eosinophils was described in a captiveborn Aotus vociferans.…”