Aneurysm of the Ascending Aorta in Systemic Lupus Erythematosus: Case Report and Review of the Literature

Overview

Journal Eur J Rheumatol

Publisher Aves

Specialty Rheumatology

Date 2017 Jun 23

PMID 28638687

Citations 5

Authors

Hector Corominas

Maria Tsokos

Martha Quezado

George C Tsokos

Affiliations

Soon will be listed here.

Abstract

Cardiovascular manifestations in patients with systemic lupus erythematosus (SLE) are common, but aortic aneurysm formation is rare. We present a 63-year-old male SLE patient with a two-year history of skin lesions, leucopenia, pericarditis, mitral valve vegetations consistent with Liebman-Sacks endocarditis, and an aneurysm of the ascending aorta, which was successfully repaired surgically. Histologic examination of the aneurysm showed medial cystic degeneration, smooth muscle necrosis, and mild adventitial perivascular lymphocytic aggregates. This histology is typical of thoracic aneurysms that carry a high risk for aortic dissection and patient death. The case highlights the importance of early detection and treatment of thoracic aortic aneurysms in patients with SLE.

Citing Articles

Inflammatory markers and calcification of coronary arteries, aorta and cardiac valves: Findings from the atherosclerosis risk in communities study.

Avula V, Mok Y, Ejiri K, Vant Hof J, Whelton S, Hoogeveen R Am J Prev Cardiol. 2025; 21:100946.

PMID: 40060173 PMC: 11889617. DOI: 10.1016/j.ajpc.2025.100946.

Olfactory Receptors and Aortic Aneurysm: Review of Disease Pathways.

Stougiannou T, Christodoulou K, Karangelis D J Clin Med. 2025; 13(24.

PMID: 39768700 PMC: 11727755. DOI: 10.3390/jcm13247778.

Fatal ascending aortic aneurysm in a patient with systemic lupus erythematosus: A case report.

Shahi T, Ghimire P, Khanal U, Dhakal T, Jha S Clin Case Rep. 2023; 11(7):e7696.

PMID: 37457996 PMC: 10340078. DOI: 10.1002/ccr3.7696.

Individualized prediction of risk of ascending aortic syndromes.

Saleh Q, Diederichsen A, Lindholt J PLoS One. 2022; 17(6):e0270585.

PMID: 35759492 PMC: 9236241. DOI: 10.1371/journal.pone.0270585.

Aortic aneurysm and dissection in systemic lupus erythematosus.

Yuan S Z Rheumatol. 2018; 78(3):287-294.

PMID: 30324280 DOI: 10.1007/s00393-018-0555-x.

References

Zhang L, Wang Y . B lymphocytes in abdominal aortic aneurysms. Atherosclerosis. 2015; 242(1):311-7. DOI: 10.1016/j.atherosclerosis.2015.07.036. View

Dessertenne G, Canaud L, Marty-Ane C, Alric P . Saccular Thoracoabdominal Aneurysms in Systemic Lupus Erythematosus. Ann Vasc Surg. 2015; 29(7):1448.e1-3. DOI: 10.1016/j.avsg.2015.03.056. View

Ohara N, Miyata T, Kurata A, Oshiro H, Sato O, Shigematsu H . Ten years' experience of aortic aneurysm associated with systemic lupus erythematosus. Eur J Vasc Endovasc Surg. 2001; 19(3):288-93. DOI: 10.1053/ejvs.1999.0982. View

Schmidt J, Sunesen K, Kornum J, Duhaut P, Thomsen R . Predictors for pathologically confirmed aortitis after resection of the ascending aorta: a 12-year Danish nationwide population-based cross-sectional study. Arthritis Res Ther. 2011; 13(3):R87. PMC: 3218902. DOI: 10.1186/ar3360. View

Burke A, Tavora F, Narula N, Tomaszewski J, Virmani R . Aortitis and ascending aortic aneurysm: description of 52 cases and proposal of a histologic classification. Hum Pathol. 2008; 39(4):514-26. DOI: 10.1016/j.humpath.2007.08.018. View

Guy A, Tiosano S, Comaneshter D, Tekes-Manova D, Shovman O, Cohen A . Aortic aneurysm association with SLE - a case-control study. Lupus. 2016; 25(9):959-63. DOI: 10.1177/0961203316628999. View

Wei H, Chung H, Wu C, Huang J . Aortic dissection complicated with hemothorax in an adolescent patient with systemic lupus erythematosus: case report and review of literature. Semin Arthritis Rheum. 2010; 41(1):12-8. DOI: 10.1016/j.semarthrit.2010.08.002. View

Kurata A, Kawakami T, Sato J, Sakamoto A, Muramatsu T, Nakabayashi K . Aortic aneurysms in systemic lupus erythematosus: a meta-analysis of 35 cases in the literature and two different pathogeneses. Cardiovasc Pathol. 2010; 20(1):e1-7. DOI: 10.1016/j.carpath.2010.01.003. View

He R, Guo D, Estrera A, Safi H, Huynh T, Yin Z . Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections. J Thorac Cardiovasc Surg. 2006; 131(3):671-8. DOI: 10.1016/j.jtcvs.2005.09.018. View

10.

Frostegard J . Prediction and management of cardiovascular outcomes in systemic lupus erythematosus. Expert Rev Clin Immunol. 2014; 11(2):247-53. DOI: 10.1586/1744666X.2015.993970. View

11.

Rached-dAstous S, Dahdah N, Brochu P, Saint-Cyr C . Rapidly progressive aortic aneurysmal dilation in a child with systemic lupus erythematosus: too early too severe. BMJ Case Rep. 2014; 2014. PMC: 4054263. DOI: 10.1136/bcr-2013-201014. View

12.

Guard R, Gotis-Graham I, Edmonds J, Thomas A . Aortitis with dissection complicating systemic lupus erythematosus. Pathology. 1995; 27(3):224-8. DOI: 10.1080/00313029500169023. View

13.

Wang S, Chang Y, Liu C, Lai C, Chen T, Chen W . Incidence and risk analysis of aortic aneurysm and aortic dissection among patients with systemic lupus erythematosus: a nationwide population-based study in Taiwan. Lupus. 2014; 23(7):665-71. DOI: 10.1177/0961203314523868. View

14.

Guo D, Papke C, He R, Milewicz D . Pathogenesis of thoracic and abdominal aortic aneurysms. Ann N Y Acad Sci. 2006; 1085:339-52. DOI: 10.1196/annals.1383.013. View

15.

Stone J, Bruneval P, Angelini A, Bartoloni G, Basso C, Batoroeva L . Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol. 2015; 24(5):267-78. DOI: 10.1016/j.carpath.2015.05.001. View

16.

Ruddy J, Jones J, Spinale F, Ikonomidis J . Regional heterogeneity within the aorta: relevance to aneurysm disease. J Thorac Cardiovasc Surg. 2008; 136(5):1123-30. PMC: 2679174. DOI: 10.1016/j.jtcvs.2008.06.027. View

17.

Hedrick C . Lymphocytes in atherosclerosis. Arterioscler Thromb Vasc Biol. 2015; 35(2):253-7. PMC: 4327776. DOI: 10.1161/ATVBAHA.114.305144. View