title: Ruptured cryptogenic mycotic abdominal aortic aneurysm by Salmonella enteritidis.
abstract: BACKGROUND
  The aim of this study is to describe a case of ruptured cryptogenic mycotic abdominal aortic aneurysm by Salmonella enteritidis (SE) and present a comprehensive review of the literature.
  
  
  METHODS
  A 66-year-old man with a past medical history of coronary artery bypass graft (CABG) and polymylagia rheumatica (PMR) presented with a 2-day history of right-flank-to-groin pain and fever. He was found to have tenderness on the right of the umbilical region and laboratory data showed leukocytosis, raised C-reactive protein, and a significant drop in hemoglobin level as compared with his first visit 17 days earlier, with no hemodynamic instability. An immediate computed tomography angiogram (CTA) was performed, which showed a 4-cm, fusiform, ruptured infrarenal aortic aneurysm. Exploratory laparatomy was performed and the aorta was isolated and excised from the infrarenal level to the common iliac bificuration. A straight silver Dacron graft soaked in rifampicin was placed with an end-to-end anastomosis. The excised aorta and the lymph nodes were sent for histologic and microbiologic assessment.
  
  
  RESULTS
  Blood culture and specimen microbiology grew Salmonella enteritidis (SE). The histology exhibited atherosclerosis at the rupture point with decreasing neutrophil deposition from the intima to the adventitia layer, respectively.
  
  
  CONCLUSIONS
  Infrarenal abdominal mycotic aneurysm (MA) by SE was observed and showed vague, nonspecific signs and symptoms. We recommend a high index of suspicion and low threshold for use of CT imaging in any infected patient of age >60 years with fever and abdominal pain on a background of diabetes and connective tissue disease. A comprehensive review of the literature was performed due to a lack of consensus on the best surgical treatment and limited information on the path of SE-induced aortitis or MA from presentation to final outcome.
authors.affiliation: Department of Vascular Surgery, Mid Essex Hospitals Services NHS Trust, Broomfield Hospital, Essex, UK. Alikordzadeh@gmail.com
authors.forename: Ali
authors.initials: A
authors.lastname: Kordzadeh
authors.forename: Karen May
authors.initials: KM
authors.lastname: Rhodes
authors.forename: Muhammad Asad
authors.initials: MA
authors.lastname: Hanif
authors.forename: Harriet
authors.initials: H
authors.lastname: Scott
authors.forename: Yiannis
authors.initials: Y
authors.lastname: Panayiotopoulos
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000785:Aneurysm, Infected / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D001019:Aortic Rupture / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D005334:Fever / Q000209:etiology; D021501:Flank Pain / Q000209:etiology; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012480:Salmonella Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D012477:Salmonella enteritidis / Q000302:isolation & purification*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome