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Xue Y, Yun XJ, Liu QY, Qi YT, Zhang LH, Jiang K, Li BD, Zhang JX. Suspected Brucella-associated descending thoracic aortic pseudoaneurysm presenting as upper gastrointestinal bleeding: A case report and review of literature. World J Gastroenterol 2027; 33(1): 123843 [DOI: 10.3748/wjg.123843]
World J Gastroenterol. Jan 7, 2027; 33(1): 123843 Published online Jan 7, 2027. doi: 10.3748/wjg.123843
Suspected Brucella-associated descending thoracic aortic pseudoaneurysm presenting as upper gastrointestinal bleeding: A case report and review of literature
Yan Xue, Xiao-Jing Yun, Qing-Yue Liu, You-Tao Qi, Li-Hui Zhang, Kun Jiang, Bao-Dong Li, Jian-Xian Zhang
Yan Xue, Xiao-Jing Yun, You-Tao Qi, Li-Hui Zhang, Department of Gastroenterology, The Second People’s Hospital of Liaocheng, Liaocheng 252600, Shandong Province, China
Qing-Yue Liu, Department of Critical Care Medicine, The Second People’s Hospital of Liaocheng, Liaocheng 252600, Shandong Province, China
Kun Jiang, Department of Cardiac and Great Vascular Surgery, The Second People’s Hospital of Liaocheng, Liaocheng 252600, Shandong Province, China
Bao-Dong Li, Department of Infectious Diseases, The Second People’s Hospital of Liaocheng, Liaocheng 252600, Shandong Province, China
Jian-Xian Zhang, Department of Gastrointestinal Surgery, The Second People’s Hospital of Liaocheng, Liaocheng 252600, Shandong Province, China
Co-first authors: Yan Xue and Xiao-Jing Yun.
Author contributions: Xue Y and Yun XJ contributed equally to this work, collected the clinical data, compiled the medical records, and drafted the initial manuscript as co-first authors; Liu QY contributed to peri-procedural critical care management and helped organize the clinical diagnostic and therapeutic reasoning; Qi YT and Zhang LH assisted with clinical data collection and manuscript revision; Jiang K performed the thoracic endovascular aortic repair procedure and provided the cardiovascular surgical details; Li BD provided infectious disease consultation and antimicrobial treatment recommendations; Zhang JX supervised the manuscript, interpreted the endoscopic findings, and critically revised the work for important intellectual content; all authors read and approved the final manuscript.
AI contribution statement: ChatGPT was used solely for linguistic refinement and formatting assistance. No AI tool was involved in generating research data, interpreting results, or formulating conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Jian-Xian Zhang, MD, Department of Gastrointestinal Surgery, The Second People’s Hospital of Liaocheng, No. 306 Jiankang Street, Liaocheng 252600, Shandong Province, China. zjx.2006@163.com
Received: June 1, 2026 Revised: July 1, 2026 Accepted: July 20, 2026 Published online: January 7, 2027 Processing time: 163 Days and 19.5 Hours
Abstract
BACKGROUND
Upper gastrointestinal bleeding is most often caused by mucosal, variceal, or malignant gastrointestinal disease. Vascular etiologies are uncommon but potentially fatal, particularly when thoracic aortic disease involves the esophagus. Brucella-associated aortic involvement is rare and may cause infectious aortitis, ulcerative destruction of the aortic wall, pseudoaneurysm, rupture, or fistulization. We report a rare case of suspected Brucella-associated descending thoracic aortic pseudoaneurysm that initially mimicked a bleeding esophageal submucosal tumor on endoscopy.
CASE SUMMARY
A 78-year-old woman was admitted with acute hematemesis and subsequently developed recurrent bleeding with a decline in hemoglobin. Urgent upper endoscopy revealed a large ulcerated posterior esophageal submucosal protrusion with an adherent dark-red clot, which was initially suspected to be a ruptured bleeding leiomyoma. Further history revealed an unexplained fever five months earlier, followed by persistent dysphagia. Contrast-enhanced computed tomography angiography (CTA) demonstrated a focal saccular pseudoaneurysm of the descending thoracic aorta, with peripheral thrombotic or inflammatory components compressing the esophagus. Emergency thoracic endovascular aortic repair achieved complete pseudoaneurysm exclusion without endoleak. Sheep exposure, subtle pre-existing aortic abnormalities on retrospective computed tomography, a strongly positive Rose Bengal test, and blood culture identification of Brucella spp. supported Brucella bloodstream infection with suspected vascular involvement. Targeted therapy with doxycycline, rifampicin, and adjunctive ceftriaxone was initiated. Postoperative fever resolved, with no recurrence since June 1, 2026. Follow-up CTA on days 9 and 25 confirmed stable exclusion without complications.
CONCLUSION
Aortic pseudoaneurysm should be excluded with CTA when atypical bleeding esophageal submucosal lesions are encountered.
Core Tip: This case highlights a rare suspected Brucella-associated descending thoracic aortic pseudoaneurysm presenting with upper gastrointestinal bleeding. The lesion initially mimicked an ulcerated esophageal submucosal tumor, which created potential diagnostic confusion. Posterior esophageal protrusion with ulceration, adherent clot, dysphagia, or unexplained fever may indicate an underlying vascular etiology; therefore, contrast-enhanced computed tomography/computed tomography angiography should be prioritized before endoscopic biopsy or therapeutic intervention. Recognition of relevant zoonotic exposure may support early consideration of infectious aortitis.
