title: Pneumococcal aortitis in the antibiotic era.
abstract: The pneumococcus remains in the antibiotic era a formidable pathogen, capable of atypical, lethal clinical presentations. We report two fatal cases of thoracic aortitis caused by Streptococcus pneumoniae in the setting of bacteremic illness from this pathogen. One case occurred in an aortic graft and the other arose in a native aorta. We also discuss the indolent clinical presentation and the diagnostic failure of transesophageal echocardiography and leukocyte scintigraphy. Persistent pyrexia with atypical chest pain and unexplained blood loss should alert clinicians to the possibility of this uncommon, yet lethal complication of pneumococcal disease.
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, New England Medical Center Hospitals, Boston, Mass, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Ioannidis
authors.forename: F
authors.initials: F
authors.lastname: Merino
authors.forename: M S
authors.initials: MS
authors.lastname: Drapkin
authors.forename: M A
authors.initials: MA
authors.lastname: Lew
authors.forename: L H
authors.initials: LH
authors.lastname: Cohn
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000382:microbiology; D001025:Aortitis / Q000175:diagnosis* / Q000382:microbiology*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis*