Suspected Brucella-associated descending thoracic aortic pseudoaneurysm presenting as upper gastrointestinal bleeding: A case report and review of literature

Table 1 Comparison of the present case with published Brucella-associated thoracic aortic aneurysmal lesions

Ref.	Age/sex	Aortic lesion	Presentation	Diagnostic evidence	Treatment	Outcome
Fuchs et al[22], 2017	69/M	Descending thoracic aorta; 82-mm false aneurysm	Dysphagia; abdominal pain; weight loss; hemoptysis/possible hematemesis; mid-esophageal ulcerative/external compression	Blood culture positive for Brucella melitensis; Brucella tube agglutination test IgM and IgG 1:80	Emergency TEVAR; gentamicin + doxycycline; doxycycline for 1 year	Asymptomatic; 3-year CTA showed good graft position and near-complete/full involution
Wang et al[23], 2017	65/M	Descending thoracic aortic pseudoaneurysm; 54 mm	Intermittent fever; chest pain; mild hemoptysis	Positive blood culture for Brucella; SAT 1:400; CTA	Rifampicin + doxycycline; covered stent-graft	Symptoms resolved; SAT negative; asymptomatic at 26 weeks
Chen et al[24], 2017	71/M	Descending thoracic rupture near celiac trunk + abdominal bifurcation rupture	Dyspnea; malaise; hypotension/acute rupture	Prior and postoperativeblood cultures confirmed Brucella melitensis	Thoracic and abdominal stent-graft exclusion; coil embolization; doxycycline + gentamicin + rifampin	Acute event controlled; discharged to rehabilitation
Alsheef et al[25], 2019	52/M	Descending thoracic aorta; saccular mycotic aneurysm with AEF	Chest/back pain; fever; weight loss; dysphagia; massive hematemesis	Two blood cultures: Brucella melitensis; CTA; TTE/TEE negative for endocarditis	Rifampin + doxycycline; urgent endovascular repair; gentamicin; planned 6-month oral therapy	Recurrent massive hematemesis; death after deterioration
Wu et al[20], 2019	65/M	Thoracic saccular aneurysm with aortobronchial fistula	Hemoptysis; feral swine hunting	Blood and aortic wall tissue cultures positive for Brucella suis; granulomatous aortitis	Open repair and fistula closure	Recurrent hemoptysis after prior TEVAR; uneventful recovery after open repair
Li and Wang[21], 2022	67/M	Thoracic penetrating ulcers with partial aneurysm formation	Left waist/buttock pain	Positive Brucella blood culture; CTA; prior Brucella abdominal pseudoaneurysm	Thoracic covered stent-graft + antimicrobial therapy	No discomfort at 6-week follow-up
Guo et al[26], 2023	65/M	Proximal descending thoracic pseudoaneurysm involving LSA/distal arch; 58 mm × 56 mm	Fever; hoarseness; previous brucellosis	Positive Brucella agglutination test; tissue mNGS: Brucella melitensis	Open arch/proximal descending aortic replacement + LSA reconstruction; antibiotics	Uneventful recovery; no recurrent fever
Present case	78/F	Descending thoracic aortic pseudoaneurysm compressing esophagus	Hematemesis; progressive dysphagia; ulcerated esophageal submucosal tumor-like lesion	RBT positive (+++); blood culture identifying Brucella spp.; sheep exposure; CTA; no tissue confirmation	Emergency TEVAR; doxycycline + rifampicin; adjunctive ceftriaxone	No recurrent bleeding or fever; POD 9/POD 25 CTA showed persistent exclusion without obvious endoleak

Only individual published cases of Brucella-associated thoracic aortic aneurysmal lesions with extractable patient-level data were included. RBT: Rose Bengal plate agglutination test; CTA: Computed tomography angiography; IgG: Immunoglobulin G; IgM: Immunoglobulin M; mNGS: Metagenomic next-generation sequencing; AEF: Aortoesophageal fistula; LSA: Left subclavian artery; POD: Postoperative day; SAT: Standard tube agglutination test; TEVAR: Thoracic endovascular aortic repair; TEE: Transesophageal echocardiography; TTE: Transthoracic echocardiography; F: Female; M: Male.