Going Round in Circles with a Multisystemic Disease: A Unique Case of Parasitic Aortitis

  • Maria Lobo Antunes Autoimmune Diseases Unit, Hospital Beatriz Ângelo, Loures, Internal Medicine Department, Hospital Beatriz Ângelo, Loures
  • Gonçalo Cabral Vascular Surgery Department, Hospital Beatriz Ângelo, Loures
  • Raquel Tavares Infectious Diseases Department, Hospital Beatriz Ângelo, Loures
  • Carla Noronha Autoimmune Diseases Unit, Hospital Beatriz Ângelo, Loure Internal Medicine Department, Hospital Beatriz Ângelo, Loures
  • José Araújo Autoimmune Diseases Unit, Hospital Beatriz Ângelo, Loures
Keywords: Aortitis, Ascaris lumbricoides

Abstract

Aortitis results from aortic inflammation, frequent causes being infections and rheumatological disorders. The authors report the case of a 33-year-old black male with recent arterial hypertension, who presented with recurrent abdominal pain, jaundice, anorexia, weight loss and diarrhoea. Laboratory work-up was compatible with inflammatory anaemia and obstructive jaundice, while abdominal imaging revealed a dilated biliary tract, no visible gallstones, cephalic pancreatic globosity and aortic thickening. Pancreatic aspirate was negative for malignant cells, bacteria and Mycobacterium tuberculosis. The jaundice spontaneously subsided and the pancreatic globosity improved over time. Following positive PPD and IGRA, isoniazid was started. However, follow-up investigations revealed a severe bulbar stenosis with intense eosinophilic infiltrate, multiple non-necrotizing granulomas, and thoracic and abdominal aortitis not previously recognized. Immunological profile (ECA, ANCA and IgG4), eggs and parasites in stool samples were negative. The multisystemic disease, with an insidious and migrating behaviour, gastrointestinal and vascular involvement, granulomatous inflammatory response and tissue eosinophilia, raised the suspicion of a parasitic infestation (despite negative screening) or vasculitis. After 7 days of empirical treatment with albendazole and ivermectin, the patient passed a specimen of Ascaris lumbricoides in the stool and improved clinically.

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  • Published: 2017-08-29

    Issue: Vol 4 No 6 (view)

    Section: Articles

    How to cite:
    Lobo Antunes, M., Cabral, G., Tavares, R., Noronha, C., & Araújo, J. (2017, August 29). Going Round in Circles with a Multisystemic Disease: A Unique Case of Parasitic Aortitis. European Journal of Case Reports in Internal Medicine, 4(6). https://doi.org/https://doi.org/10.12890/2017_000601