Kumari Pooja, Pattanaik Debendra, Williamson Claire
Division of Rheumatology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Case Rep Rheumatol. 2021 Sep 13;2021:7093607. doi: 10.1155/2021/7093607. eCollection 2021.
Aortic involvement leading to aortitis in eosinophilic granulomatosis polyangiitis (EGPA) is infrequent, and only 2 cases have been reported so far in the literature. Even more so, aortic aneurysm, secondary to EGPA, has never been reported and remains a diagnostic and therapeutic challenge. . We present a 63-year-old Caucasian male patient with a prior diagnosis of EGPA presenting with abdominal pain, nausea, and loose stools to the emergency department. Physical examination showed periumbilical tenderness. He had no peripheral eosinophilia but had high C-reactive protein and procalcitonin levels. CT abdomen revealed a mycotic aneurysm involving the infrarenal abdominal aorta. The patient declined surgical repair initially and was treated with IV antibiotics only. Unfortunately, 24 hours later, the aneurysm ruptured, leading to emergent axillofemoral bypass surgery. Surgical biopsy showed aortitis, periaortitis, and active necrotizing vasculitis.
Abdominal aneurysms should be considered a complication of EGPA, and earlier immunosuppressive therapy should be considered to prevent further complications.
嗜酸性肉芽肿性多血管炎（EGPA）导致主动脉炎的情况并不常见，迄今为止文献中仅报道过2例。更有甚者，EGPA继发的主动脉瘤从未有过报道，仍然是一个诊断和治疗难题。我们报告一名63岁的白种男性患者，此前诊断为EGPA，因腹痛、恶心和腹泻到急诊科就诊。体格检查显示脐周压痛。他外周血嗜酸性粒细胞不增多，但C反应蛋白和降钙素原水平升高。腹部CT显示一个感染性动脉瘤累及肾下腹主动脉。患者最初拒绝手术修复，仅接受静脉抗生素治疗。不幸的是，24小时后，动脉瘤破裂，导致急诊腋股旁路手术。手术活检显示主动脉炎、主动脉周围炎和活动性坏死性血管炎。
腹部动脉瘤应被视为EGPA的一种并发症，应考虑早期免疫抑制治疗以预防进一步并发症。
