Abstract
Infectious aortitis is a rare disease and associated with adverse clinical outcomes.
A 66-year-old man was admitted to the emergency department with abdominal and lower
back pain, fever, chills, and anorexia continuing for a week. A contrast-enhanced
computed tomography (CT) scan of the abdomen showed multiple periaortic enlarged lymphatic
nodes, mural wall thickening, and gas collections in the infrarenal aorta and proximal
segment of right common iliac artery. The patient was hospitalized with the diagnosis
of acute emphysematous aortitis. During hospitalization, extended-spectrum beta-lactamase-positive
Escherichia coli was grown in all blood and urine cultures. Despite sensitive antibiotherapy, abdominal
and back pain, inflammation biomarkers, and fever of the patient were not improved.
Control CT demonstrated a newly developed mycotic aneurysm, increased intramural gas
collection, and periaortic soft-tissue thickening. Urgent vascular surgery was recommended
to the patient by the heart team, but the patient rejected surgery due to the high
perioperative risk. Alternatively, an endovascular rifampin-impregnated stent-graft
was successfully implanted and antibiotics were completed at 8 weeks. After procedure,
inflammatory indicators were normalized and clinical symptoms of the patient were
resolved. No microorganism grew on control blood and urine cultures. The patient was
discharged with a good health.
Learning objective
Aortitis should be suspected in patients who present with fever, abdominal and back
pain, especially in the presence of predisposing risk factors. Infectious aortitis
(IA) accounts for a small part of all aortitis cases and the most common causative
microorganism is Salmonella. The mainstay treatment of IA is sensitive antibiotherapy. Surgery may be required
in patients who are unresponsive to antibiotics or develop aneurysm. Alternatively,
endovascular treatment can be performed in selected cases.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Cardiology CasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Aortitis: imaging spectrum of the infectious and inflammatory conditions of the aorta.Radiographics. 2011; 31: 435-451
- Infectious aortitis.Curr Treat Options Cardiovasc Med. 2005; 7: 89-97
- Emphysematous aortitis: report of two cases and CT imaging findings.BJR Case Rep. 2017; 3 (Apr 6)20170006
- The Glasgow aneurysm score as a tool to predict 30-day and 2-year mortality in the patients from the dutch randomized endovascular aneurysm management trial.J Vasc Surg. 2008; 47: 277-281
- Escherichia coli primary aortitis presenting as sequelae of incompletely treated urinary tract infection.J Vasc Surg. 2012; 55: 1779-1781
- Infectious aortitis: a life-threatening endovascular complication of nontyphoidal salmonella bacteremia.Case Rep Med. 2018; 20186845617
- Vascular graft infections, mycotic aneurysms, and endovascular infections: a scientific statement from the American Heart Association.Circulation. 2016; 134e412-60
- Mycotic abdominal aortic aneurysm in the endovascular era.Cureus. 2019; 11e6119
- Prevention of vascular graft infections with antibiotic graft impregnation prior to implantation: in vitro comparison between daptomycin, rifampin and nebacetin.Eur J Vasc Endovasc Surg. 2012; 43: 448-456
Article info
Publication history
Published online: February 14, 2023
Accepted:
January 13,
2023
Received in revised form:
December 14,
2022
Received:
October 25,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
