Abstract :
Background: Coronary artery aneurysms (CAA) are rare (0.3 – 4.9 % of angiograms) and most often due to atherosclerosis. Granulomatous infections such as tuberculosis (TB) are an exceptional cause.
Case summary: A 53-year-old Mexican man presented with an extensive anterior ST-segment-elevation myocardial infarction. Coronary angiography revealed an 8-mm fusiform aneurysm in the proximal left-anterior-descending artery with preserved TIMI III flow and no obstructive lesions. Targeted history uncovered a two-year chronic cough and weight loss. Serial sputum smears were negative, but GeneXpert MTB/RIF was positive, confirming pulmonary TB. First-line antituberculous therapy was initiated; the patient remained hemodynamically stable without recurrent ischemia.
Discussion: In TB-endemic regions, Mycobacterium tuberculosis should be considered when a CAA lacks an atherosclerotic explanation. Advanced imaging plus microbiologic testing allows accurate diagnosis and may avert unnecessary coronary intervention, as antituberculous therapy alone can lead to aneurysm regression.
Learning points: Non-atherosclerotic CAAs mandate a broad etiologic work-up, including infections. Pulmonary TB may present solely with cardiovascular complications. GeneXpert MTB/RIF is a rapid, sensitive tool in acute settings. Multidisciplinary management (cardiology + infectious diseases) could optimize outcomes.
Keywords :
Coronary Aneurysm – Tuberculosis, Pulmonary – Myocardial Infarction – Granulomatous Arteritis – Angiography – Case ReportsReferences :
- Swaye, P. S., Fisher, L. D., Litwin, P. A. U. L., Vignola, P. A., Judkins, M. P., Kemp, H. G., … & Gosselin, A. J. (1983). Aneurysmal coronary artery disease. Circulation, 67(1), 134-138.
- Syed, M., & Lesch, M. (1997). Coronary artery aneurysm: a review. Progress in cardiovascular diseases, 40(1), 77-84.
- Kawsara, A., Núñez Gil, I. J., Alqahtani, F., Moreland, J., Rihal, C. S., & Alkhouli, M. (2018). Management of coronary artery aneurysms. JACC: Cardiovascular interventions, 11(13), 1211-1223.
- Secretaría de Salud. Dirección General de Epidemiología. Boletín Epidemiológico de Tuberculosis 2022. México: SSA; 2023.
- World Health Organization. Global tuberculosis report 2023. Geneva: WHO; 2023.
- Barreto-Neto, N., Segre, A. W., Guedes, L. K., Seguro, L. P., & Pereira, R. M. (2022). Resolution of coronary arteritis following tuberculosis treatment. Journal of clinical tuberculosis and other mycobacterial diseases, 26, 100295.
- Pallangyo, P., Lyimo, F., Bhalia, S., Makungu, H., Nyangasa, B., Lwakatare, F., … & Janabi, M. (2017). Bilateral multiple pulmonary artery aneurysms associated with cavitary pulmonary tuberculosis: a case report. Journal of medical case reports, 11, 1-5.
- Yi, S., Sheng, L., & Li, W. (2022). Therapeutic effectiveness of tuberculous aneurysm and risk factors for mortality: a systematic review. General Thoracic and Cardiovascular Surgery, 70(6), 515-525.
- Schmermund, A., Baumgart, D., & Erbel, R. (1999). Potential and pitfalls of electron-beam computed tomography in detecting coronary atherosclerosis. Basic Research in Cardiology, 94, 427-444.
- Slart, R. H., Reviewer group Aiden Abidov Denis Agostini Rob S. Beanlands Roberto C. Delgado-Bolton Andrew J. Einstein Alessia Gimelli Edward J. Miller
- Roberto Sciagrà Alberto Signore, Members of EANM Cardiovascular Riemer HJA Slart Jan Bucerius Fabien Hyafil Hein J. Verberne Denis Agostini Alessia
- Gimelli Roberto Sciagrà, Members of EANM Infection & Inflammation Andor WJM Glaudemans Giorgio Treglia Olivier Gheysens Annibale Versari Alberto
- Signore, Members of Committees, SNMMI Cardiovascular Panithaya Chareonthaitawee Wengen Chen Sharmila Dorbala, Members of ASNC Panithaya Chareonthaitawee Sharmila Dorbala Aiden Abidov Rob S. Beanlands Andrew J. Einstein Edward J. Miller, & EANM Committee Coordinator Roberto C. Delgado-Bolton. (2018). FDG-PET/CT (A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. European journal of nuclear medicine and molecular imaging, 45, 1250-1269.
