Clozapine is an antipsychotic medication used to control the symptoms of schizophrenia. Due to the frequent occurrence of adverse effects, it is reserved for patients meeting the criteria of treatment-resistant schizophrenia. Among the less typical side effects of clozapine are asymptomatic eosinophilia and eosinophilic inflammation of organs such as the myocardium, as well as vasculitis, which most commonly affects small vessels in the skin. We present the case of a 54-year-old woman with treatment-resistant paranoid schizophrenia, who developed aortitis accompanied by eosinophilia as an adverse reaction to clozapine therapy. Symptoms resolved after discontinuation of the medication. The patient gave written consent for the publication of her medical case and treatment course. Inflammatory changes in large vessels such as the aorta during clozapine treatment have not been described in the literature. The coexisting eosinophilia suggests an eosinophilic nature of the inflammatory changes within the aortic wall. The presented case aims to raise awareness about possible atypical complications of the treatment and to expedite their diagnosis, which may prevent permanent negative health consequences in patients.

Clostridium septicum is an aerotolerant anaerobe classically linked to occult colorectal malignancy and hematologic disease, and a rare but frequently fatal cause of nontraumatic infective aortitis; it also causes gas gangrene, osteomyelitis and spondylodiscitis. Survival depends on radical surgical debridement, as antibiotics alone are almost uniformly fatal. We describe a 71-year-old man with untreated chronic myelomonocytic leukemia (CMML) who presented with back pain, vomiting and rigors. Computed tomography showed perforated appendicitis with extraluminal air together with mediastinitis and aortitis of the aortic arch and the aorta at the diaphragmatic hiatus. Inflammatory markers were markedly elevated and vasculitis serologies negative. The appendix was managed nonoperatively as he remained hemodynamically stable. Despite broad-spectrum antibiotics, repeat angiography on day 5 showed new aneurysmal dilatation of the arch to 5.1 cm, prompting emergent left carotid-subclavian bypass and thoracic endovascular aortic repair. On day 8, thoracotomy revealed necrotic aortic wall with an exposed endograft, which was debrided and covered with a pedicled latissimus dorsi flap; tissue cultures grew C. septicum. Colonoscopy twelve months earlier had shown only polyps and diverticulosis. He completed six weeks of intravenous ampicillin-sulbactam, was transitioned to lifelong oral suppression for retained prosthetic material, and was discharged on day 57 to long-term acute care, ventilator-dependent. This case shows that C. septicum aortitis may arise from a perforated appendix rather than a colorectal neoplasm, that nonoperative appendicitis management may give inadequate source control in an immunocompromised host, and that survival is attainable with a staged hybrid endovascular-and-open strategy.

A 55-year-old man with serologically confirmed tertiary syphilis had an asymptomatic 70 mm bilobed thoracoabdominal aortic aneurysm with two contiguous saccular components, severe T11 to T12 vertebral body erosion, complete celiac artery occlusion, and critical ostial stenosis of the superior mesenteric and right renal arteries, with mature collateral perfusion from the inferior mesenteric artery. After preoperative penicillin therapy, open repair with selective left renal artery reimplantation and intentional nonreconstruction of the chronically occluded visceral branches was completed without paraplegia or mesenteric ischemia.

Aortic thrombus is a rare and relatively underrecognized cause of peripheral embolic events, particularly ischemic stroke. It affects the elderly in most cases. It's a retrospective case series study carried out in the Neurology Department of the Hassan II University Hospital of Fez, Morocco, to analyze the epidemiological, clinical, therapeutic, and outcome data of aortic thrombus as an etiology of ischemic stroke. Eight patients were included in this study, with a mean age of 65.87 years. They were admitted with an average delay of 12 hours and 56 minutes from the onset of the neurological symptoms. The imaging protocol consisted of a non-contrast CT scan combined with CT Angiography of the polygon of Willis and supra-aortic trunks. The aortic arch was the predominant site of thrombus. Treatment consisted of curative anticoagulation for all patients, whose continuation depends on the results of control imaging. The main etiology of aortic thrombus is represented by atherosclerosis, alongside other etiologies such as thrombophilia, infectious aortitis, particularly syphilitic aortitis and antiphospholipid syndrome. The main site is the transverse thoracic aorta and the isthmus. The optimal therapeutic approach remains controversial due to the lack of large prospective series in the literature and largely relies on curative anticoagulation. The use of thrombolysis is debated due to the risk of induced peripheral emboli. Thrombectomy is reserved for specific cases.

Mycotic abdominal aortic aneurysms are rare but life-threatening vascular infections. We report a 71-year-old woman with metastatic small-cell lung cancer receiving immunotherapy. She presented with Salmonella bacteremia and was found to have a 5.4-cm eccentric saccular infrarenal abdominal aortic aneurysm with periaortic gas, inflammatory soft tissue, and a large retroperitoneal hematoma consistent with a contained rupture. Emergent endovascular aneurysm repair (EVAR) was performed. She completed six weeks of intravenous ceftriaxone followed by lifelong suppressive antimicrobial therapy. Follow-up imaging demonstrated a patent graft without endoleak. This case highlights the association between non-typhoidal Salmonella bacteremia and infectious aortitis and illustrates the role of EVAR, combined with prolonged antimicrobial therapy, in the management of mycotic abdominal aortic aneurysm with contained rupture.

Behçet's disease (BD) is a chronic multisystemic inflammatory vasculitis which can cause cardiac involvement in less than 6%. It can affect all cardiac wall giving rise to pericarditis, myocarditis, endocardial lesions with valvular involvement (especially aortic insufficiency), intracardiac thrombosis, coronary arteritis, myocardial infarcts, arrythmia, and aortitis. Clinical presentation can be confusing, silent, or overshadowed, so diagnosis is frequently delayed. Early diagnosis is mandatory and different imaging techniques play a pivotal role to screen the heart. Biological agents, including tumour necrosis factor inhibitors, show promising results. Cardiac surgery must be accompanied by immunosuppressive therapy to prevent iatrogenic or trauma-triggered pseudo aneurysm secondary to arterial hypersensitivity. A multidisciplinary approach and tailored monitoring are essential to improve patient outcome. Strong data are still lacking to define evidence-based diagnostic algorithms, risk-stratification tools, and standardised management strategies for this severe cardiac manifestation. Besides, further studies are needed to determine specific biomarkers to refine early diagnosis, assess therapeutic efficiency, and prognosis. Through a comprehensive literature review, we aim to synthesise current data on the epidemiology, clinical presentation, contemporary imaging modalities, prognosis, and evidence‑based management strategies of cardiac involvement in BD, and to highlight emerging perspectives.

Aortopathies in autoimmune rheumatic diseases (ARD) include a spectrum of aortic pathologies-including aortitis, aneurysms, dissections, and insufficiency-primarily caused by systemic inflammation. This comprehensive review investigates the clinical manifestations, pathophysiology, diagnostic modalities, and management strategies across various rheumatic diseases associated with aortopathies such as large vessel vasculitis (e.g., Takayasu arteritis, giant cell arteritis), connective tissue diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, systemic sclerosis) and less common conditions (e.g., relapsing polychondritis, Cogan's syndrome, Behçet's disease, IgG4-related disease). Disease-specific pathophysiologic mechanisms of aortic wall inflammation and remodeling, including granulomatous and lymphoplasmacytic patterns and mixed inflammatory infiltrates, are described. Diagnostic imaging modalities-such as CTA, MRI, and PET/CT-are evaluated for their roles in detecting active inflammation, assessing structural complications, and guiding clinical decision-making. Histopathological findings provide insight into disease-specific vascular changes. Management strategies focus on the use of glucocorticoids, disease-modifying antirheumatic drugs (DMARDs), and biologics, including IL-6 and TNF-α inhibitors, with an emphasis on patient-centered approaches, multidisciplinary care, and timely surgical intervention for complications. Evidence gaps include optimal screening intervals and the role of novel biomarkers in risk stratification and in monitoring disease progression, highlighting the need for early recognition, frequent monitoring, and aggressive management of aortic involvement in rheumatic diseases to prevent life-threatening complications.

We report a rare case of mitral stenosis and regurgitation after aortic valve replacement due to prosthetic valve migration. A 74-year-old woman underwent aortic valve replacement using a Carpentier-Edwards PERIMOUNT valve (Edwards Lifesciences) 9 years prior. Six years postoperatively, outpatient echocardiography incidentally revealed abnormal rocking motion of the bioprosthesis, with no signs of infection or paravalvular leak. Finally, the bioprosthetic valve interfered with the anterior mitral valve leaflet, causing severe mitral stenosis and regurgitation. Redo aortic valve replacement and mitral valve replacement with the commando procedure were performed, and pathologic findings revealed no evidence of connective tissue disease, aortitis, or infection.