title: Salmonella aortic aneurysm: suggestions for diagnosis and therapy based on personal experience--a case report.
abstract: Infectious aneurysm is a rare event, especially after the introduction of antibiotic therapy. However, its early detection is very important for timely treatment with antibiotics and surgical intervention. This pathology may generally be due to mycotic endocarditis or septic embolization, prevailing in the preantibiotic era, and to aortitis, whose incidence is actually increasing, mainly in subjects with preexisting large-vessel atherosclerosis and intimal defects. This clinical entity is usually defined as microbial arteritis and recognizes Salmonella spp as the microorganism most frequently isolated from blood or vascular tissue cultures. The authors present the case of a 56-year-old man with a history of hypertension that some weeks before admission manifested as hyperpyrexia and episodic lumbar pain, associated with hepatosplenomegaly and with a pulsing mass in the periumbilical region. Abdominal computed tomography (CT) scan documented a voluminous infrarenal aortic aneurysm with a markedly reduced and irregular vessel wall. The patient underwent surgical excision of the aneurysm, during which marked periaortic inflammation phenomena, complete absence of the posterior aortic wall for a length of 5-6 cm, and the exposure of the correspondent vertebral bodies were observed. Histopathologic examination of the aneurysmal tissue showed atheromatous and thrombotic aspects and confirmed strong signs of inflammation. This case may suggest that the occurrence of microbial aortitis, especially from Salmonella spp, should be taken into account in the presence of a septic status associated with back, abdominal, or thoracic pain.
authors.affiliation: Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy. angiologia@rm.unicatt.it
authors.forename: Valerio
authors.initials: V
authors.lastname: Cicconi
authors.forename: Stefano
authors.initials: S
authors.lastname: Mannino
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caminiti
authors.forename: Lucio
authors.initials: L
authors.lastname: Cuoco
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Fabio
authors.initials: F
authors.lastname: Vecchio
authors.forename: Francesco
authors.initials: F
authors.lastname: Snider
authors.forename: Nicolò Silveri
authors.initials: NS
authors.lastname: Gentiloni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gasbarrini
mesh_terms: D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012480:Salmonella Infections / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents