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Aortitis, a case report highlighting the need for multidisciplinary and early differential diagnosis

Ridah Shaista Shanavas, G Rama Subramanyam, Rondla Sreekanth Reddy

We present the case of a 28-year-old female patient with a history of Lower Segment Cesarean Section (LSCS) who presented with chest pain, Shortness of Breath (SOB) on exertion, sweating, and uneasiness. She was negative for diabetes, positive for hypertension, and had pedal edema during pregnancy. She had a normal hematology profile except for mild neutrophilic leukocytosis, and Anisopoikilocytosis; Her renal biochemistry and urine pathology profile were normal. The 2D echocardiogram and the doppler study indicated that she had Rheumatic valvular heart disease. The left atrium and ventricle were dilated as expected along with valve issues. Severe Aortic Regurgitation (AR) without Aortic Stenosis (AS) was noted. Mild Mitral Regurgitation (MR) without mitral stenosis was noted. Severe Tricuspid Regurgitation (TR), severe Pulmonary Arterial Hypertension (PAH), tricuspid annulus (2.6 cm), with adequate biventricular function was noted without pericardial effusion. She was advised aortic valve replacement and mitral valve repair or replacement with tricuspid valve repair with ring surgery. However, ring surgery had to be abandoned, after opening the chest, due to severe thickening and inflammation which was seen across the entire aorta. Subsequent Computed Tomography (CT) aortogram findings confirmed aortitis. Aortitis is difficult to diagnose and is usually discovered accidentally and at a much later stage resulting in a poor prognosis. Overall there is no specific preference for age or gender but certain types e.g. Takayasu Arteritis (TA) affects Asian women of reproductive age more commonly. This case and our subsequent research highlight the need to include aortitis as one of the critical complications in high-risk pregnancies especially in the Asian population. Additionally, we believe low pulse or pulseless hypertension should trigger an interdisciplinary holistic patient management for a better prognosis of young female patients.