Tuberculous (TB) aortitis is rare and usually an incidental finding on histology of patients who have undergone aortic surgery. This is a case report describing a patient presenting with abdominal pain and found to have a dissecting aortic aneurysm by CT scan, referred to Philippine Heart Center for urgent aortic repair. CT aortogram revealed an atheromatous aorta with a dissection at the aortic root. Post operatively, the patient had recurrent episodes of fever treated
as urinary tract infection and pneumonia. Histopathology of the aorta revealed cystic medial degeneration and dissection with chronic granulomatous infection. Granulomas are nonspecific findings on histopathology and must be correlated with signs and symptoms, and clinical data to diagnose TB. The patient underwent a negative AFB sputum examination and a positive TB quantiferon. Clinical presentation, CT scan findings, histopathology, and supportive modalities were used for the diagnosis of TB. Currently there are no guidelines for TB aortitis due to its rarity, but it is a differential especially in patients coming from a TB endemic country. Treatment of this case include: anti-tuberculosis treatment after emergent aortic repair, and surveillance CT aortogram. Factors that could predispose the patient to worse prognosis include age, location of aneurysm and aortic rupture. The patient is being monitored clinically and waiting for her 6-month follow up.