2019 Volume 52 Issue 11 Pages 643-649
A 76-year-old male with IgA nephropathy had been undergoing hemodialysis since the age of 64. He developed back pain and a high-grade fever during dialysis as an outpatient and was admitted to our hospital. A blood examination revealed a marked inflammatory reaction, and so we started him on antibiotics. T2-weighted magnetic resonance imaging showed hyperintensity around the aorta from the level of the origin of the renal artery to the origin of the common iliac artery. Contrast-enhanced computed tomography (CT) demonstrated a poorly marginated region with increased CT attenuation values, which was indicative of panniculitis, around the aorta. Periaortic inflammation was suspected because the aorta itself remained unchanged on the imaging scans. There was also the possibility of coexisting infective aortitis, so we initially instituted antimicrobial treatment without steroids. The patient’s blood parameters and periaortic inflammation (monitored using follow-up CT) showed some improvement, but a rapidly enlarging aneurysm appeared at the origin of the left renal artery. Due to the risk of imminent rupture, stent placement was performed emergently. Thus, our working diagnosis was an infected aneurysm of the abdominal aorta caused by infective aortitis. It is difficult to distinguish between periaortic inflammation and infective aortitis, which require different treatments. This case provides a valuable clinical lesson because it was possible to monitor the progression of infective aortitis into an aneurysm.
