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1.
BMJ Case Rep ; 17(8)2024 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-39097320

RESUMO

Mycotic aneurysm in a visceral artery due to tuberculosis (TB) is a rare occurrence. Imaging plays a critical role in its diagnosis. Over the last few years, minimally invasive interventional radiological treatment has replaced more invasive surgical procedures. Here, we report a case presenting with abdominal pain, diagnosed with jejunal artery mycotic pseudoaneurysm (PSA) secondary to TB, managed by endovascular coiling. Coil embolisation of the superior mesenteric artery branch was done using three coils, closing both the front door, back door and sac of the mycotic aneurysm. Visceral PSA following TB infection is rare and can be fatal if left untreated. Coil embolisation is a minimally invasive procedure with a high success rate and comparatively fewer complications.


Assuntos
Falso Aneurisma , Aneurisma Infectado , Embolização Terapêutica , Humanos , Falso Aneurisma/terapia , Falso Aneurisma/diagnóstico por imagem , Embolização Terapêutica/métodos , Aneurisma Infectado/terapia , Aneurisma Infectado/diagnóstico por imagem , Masculino , Jejuno/irrigação sanguínea , Aortite/terapia , Aortite/microbiologia , Procedimentos Endovasculares/métodos , Pessoa de Meia-Idade , Tuberculose Cardiovascular/terapia
2.
Semin Vasc Surg ; 37(2): 258-276, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39152004

RESUMO

Infective native arterial aneurysms and inflammatory aortic aneurysms are rare but morbid pathologies seen by vascular surgeons in the emergency setting. Presentation is not always clear, and a full workup must be obtained before adopting a management strategy. Treatment is multidisciplinary and is tailored to every case based on workup findings. Imaging with computed tomography, magnetic resonance, or with fluorodeoxyglucose-positron emission tomography aids in diagnosis and in monitoring response to treatment. Open surgery is traditionally performed for definitive management. Endovascular surgery may offer an alternative treatment in select cases with acceptable outcomes. Neither technique has been proven to be superior to the other. Physicians should consider patient's anatomy, comorbidities, life expectancy, and goals of care before selecting an approach. Long-term pharmacological treatment, with antibiotics in case of infective aneurysms and immunosuppressants in case of inflammatory aneurysms, is usually required and should be managed in collaboration with infectious disease specialists and rheumatologists.


Assuntos
Aneurisma Infectado , Antibacterianos , Aneurisma da Aorta Abdominal , Aortite , Procedimentos Endovasculares , Humanos , Aneurisma Infectado/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Aneurisma Infectado/terapia , Aneurisma Infectado/diagnóstico , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Resultado do Tratamento , Antibacterianos/uso terapêutico , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/efeitos adversos , Aortite/terapia , Aortite/diagnóstico por imagem , Aortite/diagnóstico , Fatores de Risco , Valor Preditivo dos Testes , Emergências , Aortografia , Imunossupressores/uso terapêutico , Procedimentos Cirúrgicos Vasculares , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/efeitos adversos , Serviço Hospitalar de Emergência
3.
Clin Nucl Med ; 49(9): 866-867, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38968548

RESUMO

ABSTRACT: Infectious aortitis is a challenging radiographic diagnosis due to overlapping features with the noninfectious category. We present a case of a 58-year-old woman who tested positive for SARS-CoV-2 and Streptococcus pneumoniae bacteremia. 18 F-FDG PET/CT demonstrated large vessel vasculitis involving the thoracic, abdominal aorta, and the brachiocephalic branches of the aortic arch, and an incidental subcutaneous abscess in the right arm. Standard of care treatment was administered. Within a week, a drastic improvement of the wall thickening was noted, which can be, regardless of the biological markers, a surrogate marker of an infectious aortitis.


Assuntos
Aortite , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Feminino , Aortite/diagnóstico por imagem , Pessoa de Meia-Idade , COVID-19/diagnóstico por imagem
4.
Circ Res ; 135(4): 488-502, 2024 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-38979610

RESUMO

BACKGROUND: The long isoform of the Wnk1 (with-no-lysine [K] kinase 1) is a ubiquitous serine/threonine kinase, but its role in vascular smooth muscle cells (VSMCs) pathophysiology remains unknown. METHODS: AngII (angiotensin II) was infused in Apoe-/- to induce experimental aortic aneurysm. Mice carrying an Sm22-Cre allele were cross-bred with mice carrying a floxed Wnk1 allele to specifically investigate the functional role of Wnk1 in VSMCs. RESULTS: Single-cell RNA-sequencing of the aneurysmal abdominal aorta from AngII-infused Apoe-/- mice revealed that VSMCs that did not express Wnk1 showed lower expression of contractile phenotype markers and increased inflammatory activity. Interestingly, WNK1 gene expression in VSMCs was decreased in human abdominal aortic aneurysm. Wnk1-deficient VSMCs lost their contractile function and exhibited a proinflammatory phenotype, characterized by the production of matrix metalloproteases, as well as cytokines and chemokines, which contributed to local accumulation of inflammatory macrophages, Ly6Chi monocytes, and γδ T cells. Sm22Cre+Wnk1lox/lox mice spontaneously developed aortitis in the infrarenal abdominal aorta, which extended to the thoracic area over time without any negative effect on long-term survival. AngII infusion in Sm22Cre+Wnk1lox/lox mice aggravated the aortic disease, with the formation of lethal abdominal aortic aneurysms. Pharmacological blockade of γδ T-cell recruitment using neutralizing anti-CXCL9 (anti-CXC motif chemokine ligand 9) antibody treatment, or of monocyte/macrophage using Ki20227, a selective inhibitor of CSF1 receptor, attenuated aortitis. Wnk1 deletion in VSMCs led to aortic wall remodeling with destruction of elastin layers, increased collagen content, and enhanced local TGF-ß (transforming growth factor-beta) 1 expression. Finally, in vivo TGF-ß blockade using neutralizing anti-TGF-ß antibody promoted saccular aneurysm formation and aorta rupture in Sm22 Cre+ Wnk1lox/lox mice but not in control animals. CONCLUSION: Wnk1 is a key regulator of VSMC function. Wnk1 deletion promotes VSMC phenotype switch toward a pathogenic proinflammatory phenotype, orchestrating deleterious vascular remodeling and spontaneous severe aortitis in mice.


Assuntos
Angiotensina II , Aneurisma da Aorta Abdominal , Aortite , Músculo Liso Vascular , Miócitos de Músculo Liso , Proteína Quinase 1 Deficiente de Lisina WNK , Animais , Aortite/genética , Aortite/metabolismo , Aortite/patologia , Camundongos , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Aneurisma da Aorta Abdominal/genética , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/patologia , Humanos , Proteína Quinase 1 Deficiente de Lisina WNK/genética , Proteína Quinase 1 Deficiente de Lisina WNK/metabolismo , Camundongos Endogâmicos C57BL , Masculino , Células Cultivadas , Camundongos Knockout para ApoE , Modelos Animais de Doenças , Inflamação/metabolismo , Inflamação/genética , Inflamação/patologia , Aorta Abdominal/metabolismo , Aorta Abdominal/patologia
5.
Hinyokika Kiyo ; 70(6): 179-183, 2024 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-38967031

RESUMO

An 81-year-old man with prostate cancer (cT3aN0M0), who had been undergoing hormonal therapy for 4 years and had maintained low prostate specific antigen levels, developed metastasized pelvic lymph nodes. A tissue biopsy revealed neuroendocrine differentiation of prostate cancer in the metastatic lymph nodes. Consequently, chemotherapy with carboplatin+etoposide was initiated. During the first course, filgrastim was administered for 2 days due to a drop in his neutrophil count to 230/µl. During the second course, pegfilgrastim was administered as prophylaxis on day 4. However, on day 10 of the second course, he started to develop a fever and fatigue. Suspecting infection, antibiotics were administered, but failed to ameliorate his symptoms. On day 14, plain computed tomography revealed signs of aortic inflammation. Given the lack of improvement even after one week of antibiotic therapy, steroid treatment was initiated on the suspicion of granulocyte colony-stimulating factor (G-CSF) -induced aortitis, which rapidly improved his symptoms. Therefore, when encountering a case in which a fever remains unresponsive to antibiotics during chemotherapy with G-CSF agents, a differential diagnosis of aortic inflammation caused by G-CSF agents needs to be considered.


Assuntos
Aortite , Fator Estimulador de Colônias de Granulócitos , Neoplasias da Próstata , Masculino , Humanos , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Idoso de 80 Anos ou mais , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Aortite/diagnóstico por imagem , Aortite/induzido quimicamente , Aortite/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
6.
Med Clin (Barc) ; 163(5): 217-223, 2024 09 13.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-38849269

RESUMO

BACKGROUND: IgG4-related disease (IgG4-RD) is a rare, systemic immune-mediated fibro-inflammatory condition with an unclear etiology and pathophysiology, potentially affecting multiple organs. It presents with common clinical, radiological, and serological characteristics. This study aims to compare the latest two IgG4-RD classification and diagnostic criteria: Umehara-Okazaki 2011 and ACR/EULAR 2019. MATERIAL AND METHODS: In a retrospective cross-sectional study conducted across two centers from January 2010 to July 2023, we included patients suspected of having IgG4-RD from various hospital departments. Patients finally diagnosed with other pathologies were excluded. The remaining suspected IgG4-RD cases were evaluated using both Umehara-Okazaki 2011 and ACR/EULAR 2019 criteria. RESULTS: Out of 34 patients with a clinical diagnosis of IgG4-RD, the Umehara-Okazaki 2011 classified 20 patients: 5 as definitive, 7 as probable, and 8 as possible cases. Applying the ACR/EULAR 2019 criteria to the same cohort resulted in the diagnosis of 9 patients. Notably, retroperitoneal fibrosis and aortitis were the most prevalent form of presentation, accounting for 25% and 22.2% of cases classified under the 2011 and 2019 criteria, respectively. DISCUSSION: The more recent and stringent ACR/EULAR 2019 criteria focus on histopathology, various forms of presentation, and analytical data, allow for a more accurate classification of patients.


Assuntos
Doença Relacionada a Imunoglobulina G4 , Humanos , Estudos Transversais , Estudos Retrospectivos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Fibrose Retroperitoneal/diagnóstico , Fibrose Retroperitoneal/imunologia , Aortite/diagnóstico , Aortite/imunologia
7.
Khirurgiia (Mosk) ; (5): 123-128, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38785248

RESUMO

Syphilitic aortitis is a rare disease caused by Treponema pallidum affecting the aorta and leading to inflammation. Syphilitic aortitis is one of the causes of aortic aneurysms. This article presents surgical treatment of a patient with syphilitic aortitis and thoracic aortic aneurysm. This clinical case confirms the difficulties of surgical treatment.


Assuntos
Aneurisma da Aorta Torácica , Sífilis Cardiovascular , Humanos , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/cirurgia , Sífilis Cardiovascular/complicações , Masculino , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Resultado do Tratamento , Treponema pallidum/isolamento & purificação , Implante de Prótese Vascular/métodos , Pessoa de Meia-Idade , Aortite/diagnóstico , Aortite/cirurgia , Aortite/microbiologia
8.
Cardiovasc Res ; 120(10): 1202-1217, 2024 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-38722818

RESUMO

AIMS: Abdominal aortic aneurysm (AAA) is a common, serious vascular disease with no effective pharmacological treatment. The nucleoside adenosine plays an important role in modulating vascular homeostasis, which prompted us to determine whether adenosine kinase (ADK), an adenosine metabolizing enzyme, modulates AAA formation via control of the intracellular adenosine level, and to investigate the underlying mechanisms. METHODS AND RESULTS: We used a combination of genetic and pharmacological approaches in murine models of AAA induced by calcium chloride (CaCl2) application or angiotensin II (Ang II) infusion to study the role of ADK in the development of AAA. In vitro functional assays were performed by knocking down ADK with adenovirus-short hairpin RNA in human vascular smooth muscle cells (VSMCs), and the molecular mechanisms underlying ADK function were investigated using RNA-sequencing, isotope tracing, and chromatin immunoprecipitation quantitative polymerase chain reaction (ChIP-qPCR). The heterozygous deficiency of ADK protected mice from CaCl2- and Ang II-induced AAA formation. Moreover, specific knockout of ADK in VSMCs prevented Ang II-induced AAA formation, as evidenced by reduced aortic extracellular elastin fragmentation, neovascularization, and aortic inflammation. Mechanistically, ADK knockdown in VSMCs markedly suppressed the expression of inflammatory genes associated with AAA formation, and these effects were independent of adenosine receptors. The metabolic flux and ChIP-qPCR results showed that ADK knockdown in VSMCs decreased S-adenosylmethionine (SAM)-dependent transmethylation, thereby reducing H3K4me3 binding to the promoter regions of the genes that are associated with inflammation, angiogenesis, and extracellular elastin fragmentation. Furthermore, the ADK inhibitor ABT702 protected mice from CaCl2-induced aortic inflammation, extracellular elastin fragmentation, and AAA formation. CONCLUSION: Our findings reveal a novel role for ADK inhibition in attenuating AAA via epigenetic modulation of key inflammatory genes linked to AAA pathogenesis.


Assuntos
Adenosina Quinase , Aorta Abdominal , Aneurisma da Aorta Abdominal , Músculo Liso Vascular , Miócitos de Músculo Liso , Animais , Humanos , Masculino , Camundongos , Adenosina/metabolismo , Adenosina/análogos & derivados , Adenosina Quinase/antagonistas & inibidores , Angiotensina II/metabolismo , Aorta Abdominal/patologia , Aorta Abdominal/metabolismo , Aorta Abdominal/enzimologia , Aneurisma da Aorta Abdominal/prevenção & controle , Aneurisma da Aorta Abdominal/induzido quimicamente , Aneurisma da Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/enzimologia , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/genética , Aortite/prevenção & controle , Aortite/enzimologia , Aortite/patologia , Aortite/metabolismo , Aortite/induzido quimicamente , Aortite/genética , Cloreto de Cálcio , Células Cultivadas , Modelos Animais de Doenças , Metilação de DNA , Epigênese Genética , Mediadores da Inflamação/metabolismo , Camundongos Endogâmicos C57BL , Morfolinas , Músculo Liso Vascular/enzimologia , Músculo Liso Vascular/patologia , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/efeitos dos fármacos , Miócitos de Músculo Liso/enzimologia , Miócitos de Músculo Liso/patologia , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/efeitos dos fármacos , Inibidores de Proteínas Quinases/farmacologia , Pirimidinas , Transdução de Sinais
10.
Rheumatology (Oxford) ; 63(9): 2473-2483, 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-38648749

RESUMO

OBJECTIVES: Epigenetically modified fibroblasts contribute to chronicity in inflammatory diseases. Reasons for the relapsing character of large vessel vasculitis (LVV) remain obscure, including the role of fibroblasts, in part due to limited access to biopsies of involved tissue.68Ga FAPI-46 (FAPI)-PET/CT detects activated fibroblasts in vivo. In this exploratory pilot study, we tested the detection of fibroblast activation in vessel walls using FAPI-PET/CT in LVV with aortitis. METHODS: Eight LVV patients with aortitis and eight age- and gender-matched controls were included. The distribution of FAPI uptake was evaluated in the aorta and large vessels. FAPI-uptake was compared with MRI inflammatory activity scores. Imaging results were compared with clinical parameters such as serum inflammatory markers, time of remission and medication. RESULTS: Three aortitis patients were clinically active and five in remission. Irrespective of activity, FAPI uptake was significantly enhanced in aortitis compared with controls. Patients in remission had a mean duration of remission of 2.8 years (range 1-4 years), yet significant FAPI uptake in the vessel wall was found. In remitted aortitis, MRI inflammatory scores were close to be negative, while in 4/5 patients visually identifiable FAPI uptake was observed. CONCLUSIONS: This pilot feasibility study shows significant tracer uptake in the aortic walls in LVV. FAPI positivity indicates ongoing fibroblast pathology in clinically remitted LVV.


Assuntos
Aortite , Fibroblastos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Masculino , Feminino , Aortite/diagnóstico por imagem , Aortite/patologia , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Fibroblastos/metabolismo , Fibroblastos/patologia , Projetos Piloto , Idoso , Aorta/diagnóstico por imagem , Aorta/patologia , Estudos de Casos e Controles , Radioisótopos de Gálio , Endopeptidases , Adulto , Imageamento por Ressonância Magnética/métodos , Indução de Remissão , Proteínas de Membrana
11.
Cardiovasc Pathol ; 71: 107651, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38679299

RESUMO

BACKGROUND: This study aimed to explore the clinical and pathological features of aortitis in China, which is a rare disease that is often overlooked preoperatively. METHODS: We reviewed the records of 2950 patients who underwent aortic surgery at Wuhan Asia General Hospital from 2016 to 2023. Clinical and pathological data were collected and compared across different groups. RESULTS: Out of 2950 patients, 15 had healed aortitis, 2 were healed Takayasu aortitis (TAK), and 13 were not further classified. Forty-two had active aortitis, including clinically isolated aortitis ([CIA], 42.9%), infectious aortitis ([IA], 26.2%), TAK (16.7%), and Behçet's syndrome ([BS], 14.3%), half of these cases were not recognized preoperatively. All patients who developed perivalvular leakage during follow-up had concurrent non-infectious valvulitis with mixed inflammatory pattern at the time of initial surgery. Seventeen out of 18 patients with CIA survived without complications, as did 8 out of 11 patients with IA, 6 out of 7 patients with TAK, and 2 out of 6 patients with BS. CONCLUSIONS: Half of the aortitis cases were initially diagnosed by pathologists. Noninfectious valvulitis with mixed inflammatory pattern is a risk factor for perivalvular leakage. BS is associated with a higher rate of complications. Patients with CIA have a good prognosis in China, which is different from the West.


Assuntos
Aortite , Arterite de Takayasu , Humanos , Masculino , Feminino , China/epidemiologia , Pessoa de Meia-Idade , Adulto , Aortite/patologia , Aortite/epidemiologia , Aortite/cirurgia , Arterite de Takayasu/epidemiologia , Arterite de Takayasu/patologia , Arterite de Takayasu/complicações , Estudos Retrospectivos , Idoso , Adulto Jovem , Síndrome de Behçet/complicações , Síndrome de Behçet/patologia , Síndrome de Behçet/epidemiologia , Síndrome de Behçet/diagnóstico , Fatores de Risco , Valor Preditivo dos Testes , Resultado do Tratamento , Aorta/patologia , Aorta/cirurgia , Adolescente , Prognóstico , População do Leste Asiático
12.
Int J Hematol ; 119(5): 608-612, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38521841

RESUMO

Aortitis is a rare adverse event of granulocyte colony-stimulating factor (G-CSF) treatment. Several previous studies have described recurrent aortitis caused by re-administration of the same G-CSF. However, no previous studies have examined the safety of switching between short-acting G-CSFs in patients who develop aortitis. We report the case of a 55-year-old man with refractory diffuse large B-cell lymphoma, who developed G-CSF-associated aortitis. The aortitis was triggered by filgrastim and recurred after treatment with lenograstim. The patient possessed human leukocyte antigen B52, which has been implicated in Takayasu arteritis. In addition, a drug-induced lymphocyte stimulation test for lenograstim performed upon detection of recurrent G-CSF-associated aortitis produced a positive result. Our case suggests that switching from one short-acting G-CSF to another does not prevent recurrence of G-CSF-associated aortitis. Although the etiology of G-CSF-associated aortitis has not been fully elucidated, our case also suggests that some patients may be genetically predisposed to aortitis.


Assuntos
Aortite , Fator Estimulador de Colônias de Granulócitos , Antígeno HLA-B52 , Linfoma Difuso de Grandes Células B , Humanos , Masculino , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Pessoa de Meia-Idade , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Aortite/induzido quimicamente , Aortite/etiologia , Antígeno HLA-B52/efeitos adversos , Filgrastim/efeitos adversos , Filgrastim/administração & dosagem , Lenograstim , Substituição de Medicamentos , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêutico
13.
BMJ Case Rep ; 17(3)2024 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-38538095

RESUMO

Infectious aortitis is a rare disease process which can be of fungal, viral or bacterial aetiology. This disease process is often incidentally found during concomitant infectious processes, likely due to haematogenous spread. Common sources are from cardiac, genitourinary and gastroenterologic sources. CT imaging of the aorta is essential in identifying physiological changes-wall thickness changes, ectasia and stenosis. We present a case of a female in her early 60s with a medical history of cardiomyopathy with heart failure and reduced ejection fraction, who was initially admitted for acute cholecystitis complicated by the development of gallstone pancreatitis. Imaging evaluation incidentally noted findings consistent with aortitis with a penetrating ulcer, and blood cultures were positive for Staphylococcus aureus bacteraemia, confirming her diagnosis of infectious aortitis. She was started on intravenous antibiotics, required preoperative nutritional optimisation, and subsequently underwent an open aortic resection and aortoiliac reconstruction with rifampin-soaked Dacron graft.


Assuntos
Aortite , Bacteriemia , Infecções dos Tecidos Moles , Infecções Estafilocócicas , Estados Unidos , Humanos , Feminino , Aortite/diagnóstico , Aortite/terapia , Aortite/complicações , Bacteriemia/complicações , Hospitais Militares , Infecções Estafilocócicas/complicações , Staphylococcus aureus , Infecções dos Tecidos Moles/complicações
16.
Eur Arch Otorhinolaryngol ; 281(4): 2037-2040, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38308762

RESUMO

INTRODUCTION: Immune-related adverse events (irAEs) due to immune checkpoint inhibitors may lead to discontinuation and treatment-related death. Acute aortitis is a rare but severe irAE. CASE PRESENTATION: A 67-year-old man with recurrent lower gingival carcinoma received nivolumab therapy. Twenty-three months later, he experienced chest compression, which resulted in syncope. Following a whole-body computed tomography (CT) scanning, which revealed diffuse thickening of the aorta, and systemic assessments of the causes of aortitis, he was diagnosed with acute aortitis due to irAE. Nivolumab discontinuation and oral steroids improved CT findings. However, 11 months after nivolumab discontinuation, he developed an aortic aneurysmal rupture. Endovascular aortic repair rescued him. A durable anti-cancer response was still observed 4 months after the aortic rupture. CONCLUSION: Although severe irAE, such as acute aortitis, occurred, the patient may still achieve a durable response. A broad examination and prompt treatment of irAE can help improve the patient's survival.


Assuntos
Ruptura Aórtica , Aortite , Carcinoma , Humanos , Masculino , Idoso , Nivolumabe/efeitos adversos , Aortite/induzido quimicamente , Aortite/diagnóstico por imagem , Ruptura Aórtica/induzido quimicamente , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Tomografia Computadorizada por Raios X
20.
Eur J Clin Microbiol Infect Dis ; 42(12): 1537-1541, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37882919

RESUMO

Aortitis is a life-threatening, manifestation of chronic Q fever. We report a series of 5 patients with Q fever aortitis who have presented to our hospital in tropical Australia since 2019. All diagnoses were confirmed with polymerase chain reaction (PCR) testing of aortic tissue. Only one had a previous diagnosis of acute Q fever, and none had classical high-risk exposures that might increase clinical suspicion for the infection. All patients underwent surgery: one died and 3 had significant complications. Q fever aortitis may be underdiagnosed; clinicians should consider testing for Coxiella burnetii in people with aortic pathology in endemic areas.


Assuntos
Aortite , Coxiella burnetii , Febre Q , Humanos , Febre Q/complicações , Febre Q/diagnóstico , Febre Q/epidemiologia , Queensland/epidemiologia , Aortite/diagnóstico , Aortite/complicações , Coxiella burnetii/genética , Austrália/epidemiologia
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