Disseminated Tuberculosis Complicated by Infectious Aortitis and Pseudoaneurysm in Suspected Takayasu Arteritis

Disseminated tuberculosis with aortic involvement is an uncommon but potentially fatal complication of Mycobacterium tuberculosis infection.We report the case of a 25-year-old man from Nepal with a history of renovascular hypertension secondary to renal artery stenosis diagnosed during adolescence, who presented with persistent fever, cough, anorexia, asthenia, and abdominal pain.Microbiologic evaluation confirmed smear-positive pulmonary tuberculosis without rifampicin resistance, and standard first-line antituberculous therapy was initiated.Thoracoabdominopelvic computed tomography demonstrated diffuse reticulonodular pulmonary infiltrates with cavitary lesions, calcified mediastinal lymphadenopathy, hepatosplenomegaly, and extensive aortic calcification.A large periaortic collection immediately inferior to the celiac trunk origin was also identified.Further vascular imaging demonstrated disruption of the vascular wall, critical celiac trunk stenosis, superior mesenteric artery occlusion, and bilateral renal artery occlusion.The combination of early-onset renovascular hypertension and extensive multivessel arterial disease raised suspicion of underlying Takayasu arteritis, while the periaortic lesion was considered consistent with infectious aortitis and pseudoaneurysm formation in the setting of active tuberculosis.The patient declined vascular surgical intervention.He subsequently developed sudden abdominal pain, massive gastrointestinal hemorrhage, severe metabolic acidosis, and refractory shock, followed by cardiac arrest.Autopsy demonstrated disseminated necrotizing granulomatous disease involving the lungs, kidneys, and aortic wall.Histopathologic examination of the aorta revealed transmural arteritis with neutrophilic infiltration, microabscesses, and tissue necrosis, consistent with infectious involvement of the vascular wall and pseudoaneurysm formation.This case highlights the potentially fatal vascular complications of disseminated tuberculosis and the diagnostic complexity of concomitant infectious aortic disease and suspected large-vessel vasculitis.Early recognition of aortic involvement and multidisciplinary assessment are essential in patients presenting with tuberculosis and extensive vascular abnormalities.