An infectious aortic aneurysm is a rare disease entity. We report a challenging case of a 29-year-old male presenting with chest pain and constitutional symptoms. The patient was found to have three pseudoaneurysms of the aorta on imaging, significant pathological findings of necrotizing granulomatous lymphadenitis from a supraclavicular lymph node biopsy, and a highly suggestive clinical picture of tuberculous aortitis. He was referred to vascular surgery for intervention and discharged on antituberculous therapy for 6 months. To the best of our knowledge, only five cases of tuberculous aortic aneurysms have been reported from the Middle East and North Africa (MENA) region, all with favorable outcomes. A high index of suspicion, early detection, and prompt intervention are essential in managing such cases.

The coexistence of systemic lupus erythematosus (SLE) and Crohn disease (CD) is rare and presents significant diagnostic and therapeutic challenges due to overlapping clinical, radiologic, and histologic features. We present a 24-year-old woman with SLE, chronic immune thrombocytopenic purpura, and newly diagnosed CD treated with risankizumab, an interleukin-23 inhibitor approved for CD. She achieved complete clinical and radiologic remission of CD without SLE flares over 12 months. To the best of our knowledge, this represents the first documented case of risankizumab successfully used in a patient with SLE and CD. Further research is needed to assess the long-term safety and wider applicability of interleukin-23 inhibitors for this underserved patient population.

Ocrelizumab is an anti-CD20 monoclonal antibody approved for relapsing-remitting multiple sclerosis (RRMS) that induces B-cell depletion and may increase susceptibility to infection via hypogammaglobulinemia; however, serious bloodstream infections are uncommon, and infective endocarditis (IE) is rare. We describe a 20-year-old man with RRMS, hypertension, class II obesity, and type 2 diabetes who developed persistent fever 7 days after receiving a 300-mg ocrelizumab infusion, with blood cultures growing Staphylococcus aureus. Transesophageal echocardiography demonstrated a 4-mm mobile vegetation on the atrial aspect of the P2 scallop of the posterior mitral leaflet; chest computed tomography revealed bilateral peripheral nodules consistent with hematogenous infection, and cardiac magnetic resonance imaging suggested concomitant myocarditis. The patient completed 6 weeks of intravenous cefazolin with full clinical recovery, clearance of bacteremia, and echocardiographic resolution of the vegetation. To our knowledge, this represents the second published case report of S. aureus IE temporally associated with ocrelizumab therapy. Although causality cannot be established, anti-CD20-mediated B-cell depletion may be associated with increased infection risk in susceptible hosts, particularly those with cardiometabolic comorbidities and recent corticosteroid exposure. These findings underscore the importance of early evaluation for serious infection, including IE, in patients initiating ocrelizumab who present with persistent fever or bacteremia.