ro13-9904 and Aortitis

Infectious aortitis is a rare clinical entity that most often manifests itself by an aortic aneurysm. The syphilitic or tubercular forms can be subacute. When it is caused by Salmonella sp., Staphylococcus sp. or Streptococcus pneumoniae, the aortitis is acute with alarming symptoms. Germs found in most cases are Salmonella and Staphylococcus aureus. S. pneumoniae rarely causes infectious aortitis. We report the case of a 75-year-old patient seen in an emergency setting for sudden-onset abdominal pain with fever. An abdominal angio-computed tomography (CT) scan showed a sacciform infrarenal abdominal aortic aneurysm, with an inflammatory aspect and periaortic hematoma. Surgical cure was undertaken because of the impending rupture. An interposition aortic replacement graft was implanted. Blood cultures and bacteriological study of the aortic wall isolated a S. pneumoniae. The anatomical pathology study reported fibrin clot leukocyte remodeling of the aortic wall. An intravenous antibiotic regimen was started. Several organisms, including Streptococcus, can cause infectious aortitis. We found 36 cases described in the literature in addition to our patient.

Topics: Abdominal Pain; Aged; Amoxicillin; Aneurysm, Infected; Anti-Bacterial Agents; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortitis; Bacteremia; Blood Vessel Prosthesis Implantation; Ceftriaxone; Combined Modality Therapy; Fever; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Pneumococcal Infections; Streptococcus pneumoniae; Tomography, X-Ray Computed

Topics: Adult; Anti-Bacterial Agents; Aortitis; Ceftriaxone; Fever of Unknown Origin; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Positron Emission Tomography Computed Tomography

Topics: Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortitis; Ceftriaxone; Diagnosis, Differential; Emphysema; Humans; Male; Middle Aged; Salmonella Infections; Tomography, X-Ray Computed

The infectious or inflammatory nature of an aortitis is difficult to assert because the microbiological results are often negative. The development of an aneurysm under treatment is rare, but requires a change in the therapeutic strategy and the etiologic diagnosis needs to be discussed again.. We report the case of a 69-year-old woman treated by corticotherapy for an aortitis thought to be inflammatory, who required emergency surgery when a dissected aneurysm appeared. The peroperative samples were positive to Streptococcus pneumoniae using polymerase chain reaction and allowed a change of the diagnosis. The patient evolved favorably under antibiotic therapy.. The decision to treat an aortitis by corticotherapy must be made with caution even if the microbiological tests are negative.

Topics: Adrenal Cortex Hormones; Aged; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortic Dissection; Aortitis; Ceftriaxone; Drug Therapy, Combination; Emergencies; Female; Follow-Up Studies; Gentamicins; Humans; Ofloxacin; Pneumococcal Infections; Streptococcus pneumoniae; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

Topics: Abdomen; Aged; Amoxicillin; Anti-Bacterial Agents; Aortitis; Ceftriaxone; Fever; Humans; Male; Pain; Salmonella Infections; Thailand

Infections of major vessels leading to mycotic aneurysms can be a diagnostic dilemma for clinicians, and can be accompanied by a high mortality rate. Successful treatment of this condition often requires a high index of suspicion and prompt medical and surgical attention. The authors report two cases of infectious aortitis caused by pneumococcus that evolved during hospitalization, and discuss diagnostic difficulties that accompany this entity.

Topics: Aged; Anti-Bacterial Agents; Aortic Aneurysm; Aortitis; Ceftriaxone; Female; Humans; Male; Middle Aged; Pneumococcal Infections