Wegener's granulomatosis presenting as an abdominal aortic aneurysm: a case report

Abstract

IntroductionAortic aneurysm is not common in young patient. When a young patient presents with abdominal aortic aneurysm, there may be an underlying cause.Case presentationHere, we describe a case of a 33-year-old gentleman who presented with flu like illness, chest and abdominal pains following a tooth extraction. A chest X-ray and subsequent computerised tomogram of the chest and abdomen demonstrated lung nodules and an abdominal aortic aneurysm. The aneurysm was repaired and his serology was positive for Wegener's granulomatosis. A nasal mucosal biopsy confirmed WG. He was treated with oral steroids and cyclophosphamide. His graft leaked and had to be replaced with a synthetic graft. Two months after his re-operation, he remains well.ConclusionWhenever a young patient presents with an abdominal aortic aneurysm, an underlying connective disease should be excluded because early steroid/immunosuppressive treatment may prevent the development of further aneurysms.

Aortitis with aneurysm formation as a rare complication of Wegener's granulomatosis

“…In one case, the patient died from aortic dissection. 3 In one case, 1 the patient was treated medically. This patient was diagnosed with WG assuming that the periaortitis, as seen on CT scan was caused by WG, without pathologic confirmation.…”

“…In another case, no histology was obtained because the specimen was lost. 3 The diagnosis of WG is based on four clinical criterions as defined by the Chapel Hill Consensus Conference in 1994. These are nasal or oral inflammation, abnormal chest radiograph (showing the presence of nodules, fixed infiltrates, or cavities), abnormal urinary sediment (microscopic hematuria), and granulomatous inflammation on biopsy.…”

“…Aortic involvement in WG is very uncommon. [1][2][3][4][5] It is important to recognize aortic or other large vessel involvement, due to high risk of rupture. We present a patient with abdominal aortitis with aneurysm formation as a manifestation of WG.…”

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

“…CT is an extremely accurate tool for both diagnosis and sizing of aortic aneurysms [5-9]. A longitudinal cohort study of GPA patients evaluated at the U.S. National Institutes of Health between 1968 and 1992 demonstrated that 91% experienced clinical improvement and 75% entered complete remission when treated with cyclophosphamide and methylprednisolone [7]. A meta-analysis revealed that pulse cyclophosphamide is less toxic than continuous cyclophosphamide but may be associated with a higher relapse rate [5].…”

Atypical Manifestations of Granulomatosis with Polyangiitis: The Diagnostic Challenge for Pulmonologists

“…However, a review of the literature revealed a number of cases in which the involved arteries included the aorta [66][67][68][69][70][71][72][73][74], gastric [75], subclavian [76], pulmonary [74] and internal carotid artery [39]. In most instances, depending on the artery affected, abdominal pain was the presenting symptom [66,68,[70][71]. In other cases, back pain [69,72], arm pain [76], headache due to subarachnoid hemorrhage [39] and atrioventricular block were the presenting symptoms.…”