Abstract Pulmonary tuberculosis commonly presents with low-grade fever, night sweats, cough, and mild, progressive. Massive hemoptysis, though uncommon, is a life-threatening complication. Rasmussen’s aneurysm, a rare manifestation of pulmonary tuberculosis, results from inflammatory destruction of the pulmonary artery wall adjacent to a tuberculous cavity. Here, we present a case of active tuberculosis complicated by pseudoaneurysm formation managed through interventional therapy. A 20-year-old woman from South Africa, residing in the United States on a work visa, presented with hemoptysis, fever, and, a chronic productive cough associated with weight loss. An initial flu-like illness had resolved but was followed by persistent cough and intermittent blood-streaked sputum. A prior tuberculosis skin test was negative. Chest radiography revealed multifocal pulmonary opacities, predominantly in the left lung. Computed tomography angiography revealed extensive left lung consolidation with multiple cavities, the largest measuring 4.3 × 2.2 × 3.0 cm. Laboratory studies demonstrated anemia with otherwise normal cell counts. She was treated with broad-spectrum antibiotics and transferred for further evaluation. Serial sputum cultures grew Mycobacterium tuberculosis with acid-fast bacilli, and nucleic acid amplification testing confirmed tuberculosis without rifampin resistance. She was initiated on standard therapy with rifampin, isoniazid, pyrazinamide, and ethambutol, along with pyridoxine supplementation. Several weeks later, the patient re-presented with worsening hemoptysis, estimated at 200 mL. Repeat imaging identified a 0.7-cm pseudoaneurysm in the left lower lobe. She remained hemodynamically stable with coarse breath sounds over the affected area. Interventional radiology was consulted, and she underwent successful coil embolization of the pseudoaneurysm. After decades of declining incidence, tuberculosis cases in the United States have begun to rise since the COVID-19 pandemic. This resurgence may increase the recognition of tuberculosis related complications, including hemoptysis. Rasmussen’s aneurysm occurs in approximately 5% of patients with pulmonary tuberculosis and carries a mortality exceeding 50% when associated with massive bleeding. This case highlights the need to consider pseudoaneurysm formation in patients with tuberculosis presenting with significant hemoptysis. Early diagnosis through imaging and prompt intervention are critical to survival. This abstract is funded by: None
Mina et al. (Fri,) studied this question.