False iliac artery aneurysms on a psoas abscess revealing tuberculosis disease: About a case report and review of the literature.

INTRODUCTION AND IMPORTANCE

Tuberculosis is re-emerging globally, including in Morocco. Common iliac artery aneurysms induced by tuberculosis are very rare and severe due to the risk of infection and hemorrhage, making treatment choice crucial. Only a few cases have been reported in the literature.

CASE PRESENTATION

In this article, we report a new case involving a 54-year-old man admitted to the emergency department of the university hospital for skin necrosis in the groin area with a pulsating mass in front and altered general condition, associated with night fevers that led to a chest X-ray revealing miliary tuberculosis. An emergency CT angiography showed a false aneurysm of the left common iliac artery, measuring 55 mm in diameter. The patient underwent resection of the friable portion of the iliac artery and restoration of arterial continuity through an end-to-end arterial anastomosis. Histological analysis of the surgical samples confirmed the tuberculous origin of the false aneurysm. The patient was placed on anti-tuberculous treatment, and the postoperative course was uneventful. After 6 months, the patient was asymptomatic, and the iliac axis was patent on the follow-up CT angiography.

CLINICAL DISCUSSION

Mycotic aneurysms are rarely reported, including in the carotid, iliac, femoral, and popliteal arteries. Contamination of the artery by the tuberculous mycobacterium results either from direct extension of the infection through contact with an adjacent focus or from hematogenous dissemination. Based on published cases, the evolution after appropriate medical and surgical treatment is generally favorable; however, the choice of therapy and the approach to restoring arterial continuity-vein versus prosthesis-are not well represented in the literature and depend on clinical and radiological contexts. The mortality rate remains high, with reported causes of death including aneurysmal rupture and septicemia.

CONCLUSION

The combination of anti-bacillary treatments and antibiotics, along with either open or endovascular surgery, represents the optimal therapeutic choice to ensure good outcomes and effective disease control.