Abstract
We report a case of an 80-year-old man who presented with chest pain at rest and was diagnosed with a saccular aortic arch aneurysm. His history included non-gallstone pancreatitis and cholangitis. He underwent total arch replacement. Although he was stable after surgery, on day 3 after surgery he suffered sudden hemoptysis, and a chest X-ray showed consolidation shadow in his right lung field. Although we began giving broad antibiotics, the CT finding did not clearly indicate bacterial pneumonia. We conducted COVID-19 PCR and triple sputum examination for tuberculosis, and neither result was positive. On day 15 he went into shock due to severe hemothorax, and IgG4-related arteritis was diagnosed from the heavy infiltration of IgG4 positive plasma cells in the aortic wall. Preoperative CT finding did not clearly indicate bleeding points, so we suspected alveolar hemorrhage. As soon as corticosteroid treatment began, at 30 mg/day, the consolidation shadow improved. It was uncertain that lung complication was associated with IgG4-RD, because we could not do lung biopsy considering his general condition. We switched corticosteroid administration from IV to oral without hemothorax recurrence, and he was referred on postoperative day 99. Erythrocyte sedimentation rate (ESR) is known to be a marker of IgG4-RD, and in this case ESR was the key to successful corticosteroid treatment.
