P11 | Mycotic aortic pseudoaneurism due to group B Salmonella. Case report and review of literature

S. Barp¹, P. Battisti², R. Giudice³, M. Ballardini⁴, I. Arizaj¹, R. Massaro², P. Carfagna² | ¹Medicina Interna e malattie metaboliche, Policlinico Umberto I, Università La Sapienza, Roma, ²AO San Giovanni Addolorata, Medicina Interna, Roma, ³AO San Giovanni Addolorata, Chirurgia Vascolare, Roma, ⁴AO San Giovanni Addolorata, Microbiologia, Roma, Italy

Abstract

Introduction: Intense abdominal pain associated with fever includes a wide and heterogeneous spectrum of pathologies. Mycotic aortic aneurysm (MAA) is, among these, a rare disease, associated with high mortality and with a still uncertain management.
Case report: A 74 year-old man with no significant past medical history, attended the emergency department with intensive diffuse abdominal pain, fever and diarrhea. Blood tests showed acute renal failure (creatinine 7.56 mg/dl), mild leukocytosis (WBC 10,65 x103/mcL with 86% neutrophils) and elevated CRP (19 mg/dL). An abdominal CT scan revealed voluminous infrarenal aortic aneurysm with maximum diameter of 12 cm. He was treated urgently through endovascular aortic repair (EVAR). Next blood cultures identified non-typhoidal Salmonella. Thus he started therapy with Ceftriaxone with subsequent complete resolution of symptoms and normalization of biochemical indices. Finally, he was discharged with indication of lifelong antibiotic therapy.
Conclusions: In the evaluation of abdominal pain, the presence of an aneurysm under fever is often indicative of MAA. Non-typhoidal salmonella, along with staphylococcus and streptococcus, represents one of the most frequent etiologies and must always be suspected, especially in the presence of diarrhea and renal failure. Literature review indicates that currently EVAR is the best method to reduce mortality due to the risk of rapid aneurysm breakage; there is still uncertainty about how long to carry out antibiotic therapy.