Mycobacterium tuberculosis aortic graft infection with recurrent hemoptysis: a case report

Abstract

Introduction: Mycobacterium tuberculosis may cause a large variety of clinical presentations due to its ability to disseminate by contiguity or hematogenously. Tuberculosis may remain undiagnosed for years due to the chronic course of the disease, with potentially life-threatening long-term complications.

Case presentation: In this case report, we describe a tuberculous aortic graft infection in a 72-year-old man documented by polymerase chain reaction and cultures. The patient presented with three episodes of hemoptysis following a remote history of miliary tuberculosis. The infection was treated by graft replacement and prolonged antimycobacterial therapy.

Conclusion: Tuberculous infection of a vascular graft is an uncommon complication, but should be considered in patients with an intravascular device and a history of previous tuberculosis, especially when hematogenous spread may have occurred a few months after surgery, or when an active mycobacterial infection is present in close proximity to the graft.

Figure 1

Radiographic, pathological and microbiological findings. (A) Computed tomography (CT) showing the presence of an air bubble anterior to the vascular graft, suggesting an aorto-pulmonary fistula. (B) Surgically excised Dacron prosthesis from which Mycobacterium tuberculosis DNA was amplified and M. tuberculosis grew in culture. (C) Inflammatory cells on a scraping of the prosthesis. No granuloma formation is seen (hematoxylin eosin staining). (D) Ziehl-Neelsen staining of the scraping of the prosthesis showing numerous acid-fast bacilli.