rifampin and Aortitis

Topics: Alcoholism; Amoxicillin; Aneurysm, Infected; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Aortic Aneurysm, Abdominal; Aortitis; Blood Vessel Prosthesis Implantation; Combined Modality Therapy; Discitis; Disease Susceptibility; Humans; Lumbar Vertebrae; Male; Middle Aged; Naproxen; Pneumococcal Infections; Psoas Abscess; Pulmonary Disease, Chronic Obstructive; Rifampin; Tomography, X-Ray Computed

Tuberculous aortitis is a rare entity and its association with necrosis and perforation is even more unusual. Our pulmonary medicine service originally evaluated an elderly woman with a right pleural effusion and upper lobe infiltrate thought to be tuberculosis. An abdominal CT scan performed at that time showed extensive periaortic adenopathy. Isoniazid and rifampin were started, but both were stopped by the patient after less than 6 months of therapy. The patient later had night sweats, a left pleural effusion, and a tender abdominal mass thought to be a symptomatic aneurysm. At operation, the aorta was necrotic and had an inflammatory mass and perforation on the left side. Infrarenal aortic ligation and resection were performed to control infection. A previously placed axillofemoral graft obviated the need for concomitant revascularization. The patient was treated postoperatively with isoniazid and rifampin until hyperbilirubinemia developed, which necessitated alternate therapy with ethambutol and streptomycin. The patient died one month after operation of a presumed pulmonary embolus.

Topics: Aged; Aortitis; Combined Modality Therapy; Female; Humans; Isoniazid; Necrosis; Rifampin; Rupture, Spontaneous; Tuberculosis, Cardiovascular