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.

VIEW THE ENTIRE ARTICLE

References

  • Gornik HL, Creager MA. Aortitis. Circulation 2008;117:3039–3051.
  • Ladich E, Yahagi K, Romero ME, Virmani R. Vascular diseases: aortitis, aortic aneurysms, and vascular calcification. Cardiovasc Pathol 2016;25:432–441.
  • Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 Revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 2013;65:1–11.
  • Töpel I, Zorger N, Steinbauer M. Inflammatory diseases of the aorta Part 2: infectious aortitis. Gefässchirurgie 2016;21(Suppl 2):S87–S93.
  • Grajales C, Pineda JC. Pathophysiological relationship between infections and systemic vasculitis. Autoimmune Dis 2015;2015:286783.
  • Lhote F. Systemic vasculitis during parasitosis. Presse Med 2004;33(19 Pt2):1389–13401.
  • Peng SL. Rheumatic manifestations of parasitic diseases. Semin Arthritis Rheum 2002:31:228–247.
  • Al-Zubaidy AJ. Observations on parasitic aortitis in cattle in Iraq. Trans R Soc Trop Med Hyg 1973;67:436.
  • Diouf C, Kane A, Ndoye NA, Ndour O, Faye-Fall AL, Fall M, et al. Volvulus of the small bowel due to Ascaris lumbricoides package: about a case. Pan Afr Med J 2016;24:208.
  • Khuroo MS, Rather AA, Khuroo NS, Khuroo MS. Hepatobiliary and pancreatic ascariasis. World J Gastroenterol 2016;22:7507–7517.
  • Sundriyal D, Mittal G, Kumar S, Manjunath S, Sharma N, Gupta M. Biliary ascariasis mimicking colonic tumor infiltration of the biliary system. Indian J Surg Oncol 2015;6:280–281.
  • Papparella S. Histology in diagnosis of parasitic diseases. Parasitologia 2004;46:157–158.
  • Khuroo MS. Ascariasis. Gastroenterol Clin North Am 1996;25:553–577.
  • Tietze, PE, Tietze, PH. The roundworm, Ascaris lumbricoides. Prim Care 1991;18:25.
  • Weller, PF. Eosinophilia in travelers. Med Clin North Am 1992;76:1413.
  • Views: 1126
    HTML downloads: 282
    PDF downloads: 523
    PICTURES downloads: 0
    manuscript downloads: 0
    Untitled downloads: 0


    Published: 2017-08-29
    Issue: Vol. 4 No. 6 (view)


    How to cite:
    1.
    Lobo Antunes M, Cabral G, Tavares R, Noronha C, Araújo J. Going Round in Circles with a Multisystemic Disease: A Unique Case of Parasitic Aortitis. EJCRIM 2017;4 doi:10.12890/2017_000601.

    Most read articles by the same author(s)