Miliary tuberculosis presenting as bilateral superficial femoral artery mycotic aneurysm in an immunocompetent patient

Mycotic tuberculous aneurysm is extremely rare. The aorta is the main affected artery however; iliac and less commonly femoral arteries can also be affected. In 75% of the cases a contagious focus leads to infection through erosion of the vessel wall; on the other hand direct seeding of the blood vessel wall via the vasa vasorum may occur in 25%. In a large number of patients it may be a manifestation of miliary tuberculosis. In this case report we describe an immunocompetent patient who presented with bilateral superficial femoral artery aneurysms, followed by bilateral testicular swellings and inferior mesenteric artery aneurysm, as a presentation of military tuberculosis. Early diagnosis of such patients is essential for initiation of both medical and surgical treatment in order to avoid catastrophic outcome of rupture and bleeding.