Septic rupture of an atherosclerotic plaque of the ascending aorta.
Infectious aortitis has become a rare disease thanks to the widespread use of antibiotics. We report the case of a patient who, 15 days after initiation of antibiotics for bacteraemia due to methicillin-resistant Staphylococcus aureus (MRSA), developed acute chest pain followed by haemodynamic instability. A tamponade due to a rupture into the pericardium of the ascending aorta at the site of an atherosclerotic plaque was diagnosed by an emergent chest contrasted computed tomography (CT). Intraoperatively, the septic nature of the rupture was suspected. All aortic atherosclerotic plaque samples grew MRSA. Postoperatively, the patient had an uneventful recovery after 12 weeks of antibiotic therapy. Transoesophageal echocardiography and chest CT were normal at 3 months after cessation of antibiotics. This case report permits the review of some characteristics of this disease, its physiopathology as well as the therapeutic implications.
Department of Cardiovascular and Thoracic Surgery, Centre Cardiologique du Nord, Saint-Denis, France. jm.maillet@ccncardio.com
Jean Michel
JM
Maillet
Tonino
T
Palombi
Jean-Louis
JL
Sablayrolles
Nicolas
N
Bonnet
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001019:Aortic Rupture / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D001025:Aortitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D050197:Atherosclerosis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000209:etiology; D017548:Echocardiography, Transesophageal; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D058226:Plaque, Atherosclerotic; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D012086:Reoperation; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents