van der Zwaan Heleen B, Sieswerda Gertjan Tj, Krings Gregor J, Voskuil Michiel
Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Eur Heart J Case Rep. 2020 May 3;4(3):1-5. doi: 10.1093/ehjcr/ytaa081. eCollection 2020 Jun.
Aortitis is a rare condition that can be caused by inflammatory or infectious aetiologies. The clinical presentation of aortitis includes a heterogeneous range of symptoms and clinical signs.
We present a 53-year-old man whose medical history included presence of a ventricular septal defect, a bicuspid aortic valve, and coarctation of the aorta. The coarctation was treated with percutaneous stent implantation. One and a half years later, he presented to our hospital with complaints of fatigue, night sweats, and shivers. Physical examination revealed a fever, tachycardia, and hypertension. Imaging studies showed no signs of endocarditis. Positron emission tomography-computed tomography (PET-CT) showed an increase in F-fluorodeoxyglucose uptake at the distal end of the stent in the descending aorta. Blood cultures revealed a and antibiotic treatment was adjusted accordingly. The patients' functional status improved quickly, the fever resolved, and the laboratory markers of inflammation returned to normal.
Aortitis is extremely rare after stent implantation. Risk factors for aortitis include congenital vascular malformation and stent implantation. Computed tomography is currently the imaging study of choice for aortitis, while PET-CT seems ideal for identification of stent infection. Mortality associated with infectious aortitis ranges from 21% to 44%, with generally higher mortality if managed with antibiotics alone. The differential diagnosis of stent infection should be taken into account in patients presenting with fever and chills after previous stent procedures.
主动脉炎是一种罕见疾病，可由炎症性或感染性病因引起。主动脉炎的临床表现包括一系列不同的症状和体征。
我们报告一名53岁男性，其病史包括室间隔缺损、二叶式主动脉瓣和主动脉缩窄。主动脉缩窄通过经皮支架植入术进行治疗。一年半后，他因疲劳、盗汗和寒战前来我院就诊。体格检查发现发热、心动过速和高血压。影像学检查未发现心内膜炎迹象。正电子发射断层扫描-计算机断层扫描（PET-CT）显示降主动脉支架远端的氟脱氧葡萄糖摄取增加。血培养结果显示……并据此调整了抗生素治疗。患者的功能状态迅速改善，发热消退，炎症实验室指标恢复正常。
支架植入术后主动脉炎极为罕见。主动脉炎的危险因素包括先天性血管畸形和支架植入。计算机断层扫描目前是主动脉炎的首选影像学检查，而PET-CT似乎是识别支架感染的理想方法。感染性主动脉炎的死亡率在21%至44%之间，如果仅用抗生素治疗，死亡率通常更高。对于既往有支架置入术且出现发热和寒战的患者，应考虑支架感染的鉴别诊断。
