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Salmonella Aortic Aneurysm: Suggestions for Diagnosis and Therapy Based on Personal Experience

A Case Report

Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy, angiologia{at}rm.unicatt.it

Stefano Mannino, MD

Department of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy

Giuseppe Caminiti, MD

Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy

Lucio Cuoco, MD

Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy

Antonio Gasbarrini, MD

Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy

Fabio Vecchio, MD

Department of Pathology, Catholic University of the Sacred Heart, Rome, Italy

Francesco Snider, MD

Department of Cardiovascular Surgery, Catholic University of the Sacred Heart, Rome, Italy

Nicolò Silveri Gentiloni, MD

Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy

Giovanni Gasbarrini, MD

Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy

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.

Angiology, Vol. 55, No. 6, 701-705 (2004)
DOI: 10.1177/00033197040550i613


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