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Cureus Feb 2024Pegylated granulocyte colony-stimulating factor (G-CSF), commonly used in chemotherapy-induced neutropenia, has been associated with rare instances of aortitis. This...
Pegylated granulocyte colony-stimulating factor (G-CSF), commonly used in chemotherapy-induced neutropenia, has been associated with rare instances of aortitis. This study describes a 67-year-old female patient with estrogen receptor (ER)-positive, human epidermal growth factor receptor-2-positive breast cancer, undergoing chemotherapy with an epirubicin/cyclophosphamide (EC) regimen (epirubicin, cyclophosphamide) and pegylated G-CSF for neutropenia prophylaxis. Post-treatment, she developed symptoms including intermittent fever and severe arthralgia. Laboratory tests revealed an elevated white blood cell count, C-reactive protein levels, and erythrocyte sedimentation rate, while a computed tomography scan showed thickening in the aortic arch and descending aorta. Given the clinical presentation and exclusion of other potential causes, pegylated G-CSF-induced aortitis was suspected. The patient's symptoms improved significantly following the cessation of pegylated G-CSF, aiding in the differentiation from other types of aortitis. This study highlights the importance of considering pegylated G-CSF as a potential cause of aortitis in patients presenting with unexplained symptoms of fever and inflammation after chemotherapy. The rapid improvement upon discontinuation of the drug is a key feature distinguishing it from other aortitis causes. In conclusion, while rare, aortitis should be considered in the differential diagnosis of patients treated with pegylated G-CSF who exhibit relevant clinical symptoms. Early detection and management, including the discontinuation of the causative agent, are crucial for patient recovery and prognosis.
PubMed: 38533155
DOI: 10.7759/cureus.54845 -
QJM : Monthly Journal of the... Mar 2024
PubMed: 38532306
DOI: 10.1093/qjmed/hcae053 -
Cureus Feb 2024Infected aortic aneurysm is a rare but fatal disease that occurs through various mechanisms. In this report, we describe the case of a patient who was hospitalized for...
Infected aortic aneurysm is a rare but fatal disease that occurs through various mechanisms. In this report, we describe the case of a patient who was hospitalized for acute pneumonia and developed an infected aortic aneurysm in the descending aorta during the hospitalization. A 73-year-old Japanese man presented to the emergency department with a chief complaint of fever. He had a history of chronic renal failure due to nephrosclerosis and was on regular hemodialysis three times a week. The patient presented with an elevated inflammatory response, anemia, and low platelet counts after various tests. Computed tomography (CT) showed ground-glass opacity in the left lung with a small amount of pleural effusion, leading to a diagnosis of pneumonia. The patient was admitted to the hospital on the same day, and a course of antibiotics (ceftriaxone [CTRX]) was started. On the fourth day of hospitalization, (MSSA) was detected in the blood sample, which was collected from the patient on the day of admission. The patient was treated for MSSA pneumonia and bacteremia, and the antibiotics were changed to cefazolin (CEZ). Treatment with antimicrobials resulted in a negative blood culture retest on day 5 and improvement of the inflammatory response. On the 12th day, improvements in pneumonia and pleurisy were observed on the CT scan; however, an abnormal bulge was seen on the dorsal side of the descending thoracic aorta with suspected partial vessel wall disruption, suggesting a ruptured infected aortic aneurysm. Despite treatment with antibiotics, the thoracic descending aortic aneurysm continued to dilate with progressing rupture, and the patient died on the 25th day of hospitalization. This is the first report of an infected aneurysm caused by Staphylococcus aureus, despite a negative blood culture. Patients at high risk might develop infected aneurysms, and the possibility of rapid dilation should always be considered.
PubMed: 38523983
DOI: 10.7759/cureus.54674 -
Cureus Feb 2024Non-typhoidal typically presents with gastroenteritis. However, an invasive infection, which may be typically seen in immunocompromised patients, has a propensity for...
Non-typhoidal typically presents with gastroenteritis. However, an invasive infection, which may be typically seen in immunocompromised patients, has a propensity for aortic involvement, especially in patients with risk factors for atherosclerosis. Here we present a 60-year-old female with multiple comorbid conditions and currently on immunosuppressants for rheumatoid arthritis, who presented with nausea, vomiting, and fever of three weeks duration and was found to have bacteremia. Blood cultures were positive for . Computed tomography (CT) abdomen with contrast was concerning for mycotic aortitis. The patient underwent endovascular repair of an aortic ulcer and was treated with a six-week course of ceftriaxone. Mycotic aneurysm is a rare but potentially fatal complication of invasive infection. It occurs typically in older men with atherosclerotic risk factors. It mostly presents as fever, back pain, and/or abdominal pain. Our patient was a middle-aged female who presented with non-specific symptoms. CT angiogram is the diagnostic modality of choice and treatment may require surgical vascular repair and long-term antibiotics. A high level of suspicion is needed to diagnose mycotic aneurysm/aortitis. Early diagnosis and treatment may improve the mortality.
PubMed: 38523940
DOI: 10.7759/cureus.54645 -
International Journal of Hematology May 2024Aortitis is a rare adverse event of granulocyte colony-stimulating factor (G-CSF) treatment. Several previous studies have described recurrent aortitis caused by...
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.
Topics: Humans; Male; Granulocyte Colony-Stimulating Factor; Middle Aged; Lymphoma, Large B-Cell, Diffuse; Aortitis; HLA-B52 Antigen; Filgrastim; Lenograstim; Drug Substitution; Recombinant Proteins
PubMed: 38521841
DOI: 10.1007/s12185-024-03744-w -
American Heart Journal Plus :... Dec 2023Non-atherosclerotic causes of acute coronary syndrome (ACS) are important contributors to a substantial number of acute ischemic coronary events. Syphilitic aortitis is...
INTRODUCTION
Non-atherosclerotic causes of acute coronary syndrome (ACS) are important contributors to a substantial number of acute ischemic coronary events. Syphilitic aortitis is a rare complication of tertiary cardiovascular syphilis that may result in ostial coronary artery stenosis, aortic insufficiency, and ascending aortic aneurysm.
METHODS
In this manuscript, we present two Case Reports of patients with bilateral syphilitic coronary artery ostial occlusion, and we review the associated literature. The immunofluorescent test was positive for syphilis in both patients.
RESULTS
Diagnostic coronary angiography revealed bilateral occlusions of the left main coronary artery (LMCA) and right coronary artery (RCA), which were successfully treated with percutaneous coronary intervention (PCI) with bare metal stents (BMS). After deployment of the stents, arterial blood flow was re-established with TIMI flow grade 3.
DISCUSSION
The angiographic finding of bilateral coronary ostial lesions in young patients should raise the suspicion of cardiovascular syphilis. Options for revascularization should be discussed amongst the patient and the Heart Team. PCI may be an option for treatment of isolated syphilitic coronary stenosis in the setting of acute hemodynamic instability or chronic inflammation.
PubMed: 38510102
DOI: 10.1016/j.ahjo.2023.100337 -
Clinical Radiology Jun 2024To evaluate the diagnostic performance of 2-[F]-fluoro-2-deoxy-d-glucose (F-FDG) positron-emission tomography (PET)/computed tomography (CT) in TA diagnosis and Takayasu...
AIM
To evaluate the diagnostic performance of 2-[F]-fluoro-2-deoxy-d-glucose (F-FDG) positron-emission tomography (PET)/computed tomography (CT) in TA diagnosis and Takayasu arteritis (TA) activity assessment.
MATERIALS AND METHODS
This retrospective study included patients with TA diagnosed according to the American College of Rheumatology (ACR) criteria and undergoing F-FDG PET/CT imaging from October 2010 to July 2022. TA activity was assessed through F-FDG PET/CT (maximum standard uptake value [SUVmax], vascular SUVmax/mean standard uptake value [SUVmean] of liver (SUV ratio), and PET vascular activity score [PETVAS]) using physician global assessment (PGA) as the reference standard, and the results of these assessments were compared against the clinical activity scores (National Institutes of Health [NIH] and Indian Aortitis Disease Activity [ITAS-A] scores), acute-phase reactants (APR), and white blood cell and platelet counts.
RESULTS
Twenty F-FDG PET/CT examinations from 19 patients were included in the study, nine were performed in the active phase and 11 in the inactive phase. The involved vessels showed segmental and tubular FDG uptake in the active group. The average SUVmax, SUV ratio, and PETVAS was 6.3 ± 2.7 (range 3.4-12), 4.2 ± 1.7 (range 2.1-7.5), and 22.7 ± 11.2 (range 6-39), respectively, in the active group and 1.7 ± 0.9 (0.9-3.1), 1.1 ± 0.6 (range 0.6-2.4), and 3.5 ± 5.5 (range 0-18), respectively, in the inactive group. The sensitivity, specificity of SUVmax, SUV ratio, and PETVAS for TA activity assessment were 100%, 100%; 100%, 90.9%; and 88.9, 90.9%, respectively. After ROC curve analysis, a new SUVmax cut-off was obtained. Based on the new cut-off value, SUVmax 3.3 and SUV ratio 1.9 had a more perfect assessment performance.
CONCLUSION
F-FDG PET/CT is an alternative imaging technique for TA.
Topics: Humans; Takayasu Arteritis; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography; Female; Retrospective Studies; Radiopharmaceuticals; Male; Adult; Middle Aged; Young Adult; Adolescent; Sensitivity and Specificity
PubMed: 38492999
DOI: 10.1016/j.crad.2024.01.020 -
Autopsy & Case Reports 2024We report the case of a 77-year-old male who suffered from hypertension and died suddenly. At autopsy, he was found to have hypertensive cardiomegaly and a dissecting...
We report the case of a 77-year-old male who suffered from hypertension and died suddenly. At autopsy, he was found to have hypertensive cardiomegaly and a dissecting syphilitic saccular aneurysm of the ascending aorta and arch with tamponade. Chronic aortic regurgitation, which is often seen in syphilitic aortitis, produces an additive effect to the concentric left ventricular hypertrophy seen in hypertension.
PubMed: 38487034
DOI: 10.4322/acr.2024.475 -
Radiology. Cardiothoracic Imaging Apr 2024Immunoglobulin 4 (IgG4)-related disease is a chronic immune-mediated fibroinflammatory disorder. Involvement of the vascular system, including large- and medium-sized...
Immunoglobulin 4 (IgG4)-related disease is a chronic immune-mediated fibroinflammatory disorder. Involvement of the vascular system, including large- and medium-sized vessels, is increasingly recognized. The varied appearances of vascular involvement reflect the sequela of chronic inflammation and fibrosis and can include aortitis and periaortitis with resultant complications such as aneurysm formation and dissection. A diagnosis of IgG4-related large vessel involvement should be considered when there is known or suspected IgG4-related disease elsewhere. Other organs that are typically affected in IgG4-related disease include the lacrimal and salivary glands, thyroid, pancreas, biliary tree, lungs, kidneys, and meninges. Diagnosis typically requires careful correlation with clinical, imaging, serum, and pathologic findings. Patients may be managed with corticosteroid therapy or the anti-CD20 monoclonal antibody, rituximab, if needed. The varied clinical presentations and imaging features of large vessel involvement are discussed herein. Vascular, Inflammation, Aorta, IgG4-related Vessel Involvement © RSNA, 2024.
Topics: Humans; Immunoglobulin G4-Related Disease; Immunoglobulin G; Multimodal Imaging; Aorta; Inflammation
PubMed: 38483247
DOI: 10.1148/ryct.230105 -
European Heart Journal. Case Reports Mar 2024Syphilis, owing to its natural course, can lead to long-term damage to the aortic valve, such as insufficiency and rarely stenosis, ostial coronary stenosis, and...
BACKGROUND
Syphilis, owing to its natural course, can lead to long-term damage to the aortic valve, such as insufficiency and rarely stenosis, ostial coronary stenosis, and syphilitic aortitis. Cardiovascular involvement alongside neurological involvement dominates the prognosis. This should no longer be seen, thanks to awareness and prevention programmes, medical treatment, and antibiotics.
CASE SUMMARY
We report a case of a 54-year-old chronic smoker with no previous history, admitted for respiratory distress amid an impaired general condition. An electrocardiogram was performed, which showed sinus rhythm with lateral ST depression and -wave inversion. Coronary angiography revealed an ostial stenosis of the left coronary artery. Echocardiography displayed a globular dilated left ventricle with a left ventricular ejection fraction of 40% and severe aortic insufficiency (AI). Computed tomography angiography of the aorta showed a dilation of the thoracic aorta and suprarenal abdominal aorta. Syphilitic serology was positive. The patient underwent angioplasty, resulting in a satisfactory outcome, and subsequently received optimal treatment. Following a consultation with a cardiovascular surgeon and vascular team, it was decided to proceed with mechanical aortic valve replacement and aorto-coronary double bypass surgery, but vascular surgery of the ascending aortic aneurysm was not possible at once.
DISCUSSION
Tertiary syphilis should always be considered when faced with isolated coronary ostial involvement, aortic aneurysm, and/or AI. What makes our case special is that the patient had almost all the cardiovascular complications of tertiary syphilis. Primary syphilis should always be prevented, diagnosed early, and treated appropriately with antibiotic therapy.
PubMed: 38476287
DOI: 10.1093/ehjcr/ytae013