A rare case report of Rasmussen's aneurysm in multidrug-resistant tuberculosis from Nepal.

Introduction and Importance: Rasmussen's aneurysm is a radiological finding and an uncommon cause of hemoptysis in pulmonary tuberculosis. It results from weakening of pulmonary arterial wall due to inflammation adjacent to a tuberculous cavity. Case presentation: We report a case of 52-year-old male diagnosed with pulmonary tuberculosis, who presented with recurrent hemoptysis despite being on anti-tubercular therapy. Bacteriological examination using line probe assay revealed resistance to Rifampicin and Isoniazid, confirming multidrug resistant tuberculosis (MDR-TB). CT pulmonary angiogram (CT-PA) was performed, which demonstrated a dilated vascular channel adjacent to a cavity in the left upper lobe of the lung, suggestive of Rasmussen's aneurysm. It was managed with trans-arterial embolization, followed by initiation of second-line regimen for MDR-TB. Clinical discussion: As Rasmussen's aneurysm is rare, it is often overlooked when a TB case presents with massive hemoptysis. If left untreated, it could be fatal. This case highlights the utility of prompt investigation and intervention to manage the complication and prevent further deterioration. Conclusion: Rasmussen's aneurysm is a rare cause of hemoptysis, especially in cavitary or MDR-TB. Early diagnosis with CT-PA and management with endovascular approach could be life-saving.