title: Abdominal aortitis due to Streptococcus pneumoniae and Enterobacter aerogenes: a case report and review.
abstract: Endovascular infections are 1 cause of fever of unknown origin. We describe a diagnostically challenging case of cryptogenic abdominal aortitis from Streptococcus pneumoniae and Enterobacter aerogenes. A 72-year-old male presented with epigastric pain, fevers, and chills. A computed tomography scan demonstrated enlargement and ulceration of the distal abdominal aorta, prompting urgent vascular surgery. Intraoperative tissue cultures grew S. pneumoniae and E. aerogenes and gatifloxacin was administered for 6 weeks. Spontaneous abdominal aortitis is uncommon and usually due to a single pathogen. This is the second reported case of polymicrobial infectious aortitis and to date, Enterobacter has only been reported in infected aortic grafts. Clinicians should maintain a high index of suspicion for infectious aortitis as the mortality, if only treated medically, approaches 100%.
authors.affiliation: Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA. matthew.rondina@hsc.utah.edu
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Rondina
authors.forename: Kalani
authors.initials: K
authors.lastname: Raphael
authors.forename: Robert
authors.initials: R
authors.lastname: Pendleton
authors.forename: Merle A
authors.initials: MA
authors.lastname: Sande
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D001025:Aortitis / Q000382:microbiology*; D017023:Coronary Angiography; D021902:Enterobacter aerogenes / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000175:diagnosis* / Q000188:drug therapy; D024841:Fluoroquinolones / Q000627:therapeutic use*; D000077734:Gatifloxacin; D006801:Humans; D008297:Male; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
chemical_list: D024841:Fluoroquinolones; D000077734:Gatifloxacin