SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Thoracic Aortitis Associated With Myelodysplastic Syndrome

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This case describes a 75-year-old man who presented with 4 weeks of malaise and a petechial lower-extremity rash, followed by cough, rhinorrhea, fever, and acute chest pain. Initial evaluation showed tachycardia and imaging consistent with active descending thoracic aortitis, along with ground-glass changes suggesting a concurrent viral respiratory infection. Laboratory findings, including peripheral smear abnormalities (blasts and teardrop cells), and bone marrow biopsy confirmed myelodysplastic syndrome (MDS), while the respiratory panel identified RSV.<br /><br />The patient was initially treated with broad-spectrum antibiotics because infectious aortitis was a major concern. However, extensive infectious workup was negative for bacterial and fungal causes, and rheumatologic testing (ANA, rheumatoid arthritis markers, ACE) was unrevealing. Given the association between MDS and autoimmune phenomena, he was started on prednisone at 1 mg/kg for presumed paraneoplastic aortitis secondary to MDS. A repeat CT scan three months later showed resolution of the aortitis, supporting the diagnosis.<br /><br />The discussion emphasizes that aortitis may be infectious or inflammatory, with common inflammatory causes including giant cell arteritis and Takayasu arteritis. MDS is known to be associated with systemic inflammatory and autoimmune complications in roughly 10–20% of patients, but aortitis is rare. The proposed mechanism involves immune dysregulation, including dysfunctional T-cell activity related to dysplastic hematopoiesis. Presentation can be nonspecific, ranging from fever and chest pain to vascular insufficiency or aneurysm.<br /><br />This case highlights the importance of considering MDS-associated aortitis in patients with unexplained vascular inflammation, while carefully excluding infectious causes before initiating immunosuppression. Proper diagnosis has major prognostic and treatment implications, since steroids may be beneficial in paraneoplastic aortitis but harmful in infectious disease.

Asset Subtitle

Cindy Fang

Meta Tag

Author List Alexander Bareis, Cindy Fang

Category Clinical Vignettes

Concept Myelodysplastic Syndrome

Concept Aortitis

Concept Infectious Aortitis

Concept Glucocorticoid Therapy

Concept Imaging

Distinguished Non-Finalist

Presenter Organization Nyu

Presenting Author Cindy Fang

Track Adult

Keywords

myelodysplastic syndrome

aortitis

paraneoplastic inflammation

prednisone

infectious aortitis

RSV infection

thoracic aorta

autoimmune complications

chest pain

vascular inflammation

Myelodysplastic Syndrome

Aortitis

Infectious Aortitis

Glucocorticoid Therapy

Imaging