Suspected Giant Cell Aortitis: From Multiple Aortic Structural Damage to Fatal Listeria Sepsis, a Case Report.
Giant cell arteritis (GCA) is an inflammatory vasculopathy affecting large- and middle-sized vessels, specifically cranial arteries derived from carotid artery. Isolated extracranial vessel involvement can occur. Interest in extravascular manifestations is recently increasing because of diffusion of sensitive and specific imaging tools such as fluorodeoxyglucose positron emission tomography computerized tomography (18 FDG PET CT). Patients have an increased relative risk of severe infection. Listeria monocytogenes infection risk is increased, and vascular system involvement and graft infection have been, although rarely, reported. We report the case of a 72-year-old woman with a history of suspected giant cell aortitis, previous surgical treatment of ascendant and descendant thoracic aortic aneurysm, presenting 7 years after thoracic endovascular aneurysm repair with thoracic pain, fever, inflammatory indexes increase, leukocytosis, Listeria sepsis, and rapidly increasing type I proximal endoleak on CT. 18 FDG PET positivity was associated. Endograft listeria infection on aortitis reactivation was suspected, but death for multiorgan failure and absence of autopsy data could not confirm diagnosis. Listeria vascular graft infection has been reported previously. GCA is a predisposing condition. We report the first case of endograft infection by L monocytogenes in a patient with a positive history of suspected giant cell aortic aneurysm.
Dipartimento di Chirurgia Generale e Specialistica Paride Stefanini, Università La Sapienza Rome, Rome, Italy. Electronic address: valeria.silvestri@uniroma1.it.
Valeria
V
Silvestri
Vascular and Endovascular Surgery, Ospedale Santa Maria Misericordia, Perugia, Italy.
Giacomo
G
Isernia
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D000072226:Computed Tomography Angiography; D003287:Contrast Media / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage; D013700:Giant Cell Arteritis / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008088:Listeriosis / Q000175:diagnosis / Q000382:microbiology*; D009102:Multiple Organ Failure; D049268:Positron-Emission Tomography; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology*; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology*; D051598:Whole Body Imaging / Q000379:methods
D003287:Contrast Media; D019788:Fluorodeoxyglucose F18