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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Non-infectious aortitis in an immunosuppressed renal transplant recipient with IgA nephropathy
  1. Charlotte M Snead,
  2. Stephen C Crockett,
  3. Phillippa K Bailey
  1. Richard Bright Renal Service, Southmead Hospital, Bristol, UK
  1. Correspondence to Dr Charlotte M Snead, csnead{at}doctors.net.uk; charlotte.snead{at}nbt.nhs.uk

Summary

A 54-year-old woman presented with atypical chest pain, fever and malaise. She was immunosuppressed with three agents following a living-donor kidney transplant 1 year previously. Her native kidney failure was secondary to biopsy-demonstrated crescentic IgA nephropathy, with systemic involvement. A CT pulmonary angiogram revealed an inflammatory cuff of soft tissue around the descending thoracic aorta suggesting aortitis. Inflammatory markers were elevated. Given her immunosuppression, the patient was screened extensively for infective causes and was empirically commenced on intravenous meropenem. After 72 hours of no clinical or serological response to antibiotic therapy, negative microbiological investigations and worsening inflammation on serial imaging, she was commenced on high-dose methylprednisolone for presumed inflammatory aortitis. Symptoms and inflammatory markers rapidly normalisedand the patient was discharged home on oral prednisolone. A clinical diagnosis of IgA-related aortitis was made. Imaging 3 months later showed complete resolution of the aortitis.

  • chronic renal failure
  • renal transplantation
  • connective tissue disease
  • vasculitis
  • renal system

https://doi.org/10.1136/bcr-2017-221136

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    Footnotes

    • Contributors CMS, SCC and PKB were part of the clinical team responsible for the patient’s care during the reported presentation, conceived and planned the case report. CMS and SCC acquired the data regarding the case and investigation results. SCC and PKB reviewed and summarised the existing relevant medical literature, provided feedback on the first draft and approved the final submitted version. CMS wrote the first draft of the report, edited further versions of the draft and did a further literature review.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.