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Anucha Apisarnthanarak, Opas Satdhabudha, Piyaporn Apisarnthanarak, Narathip Chunhamaneewat, J. Russell Little, Linda M. Mundy, A 66-Year-Old Thai Man with Fever and Abdominal Pain, Clinical Infectious Diseases, Volume 39, Issue 9, 1 November 2004, Pages 1385–1386, https://doi.org/10.1086/424674
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Diagnosis: Salmonella group D aortitis (infrarenal portion).
After the CT scan was obtained (figure 1), the patient underwent abdominal aneurysmectomy with axillobifemoral graft. Two specimens of the abdominal aneurysm were obtained for culture. There were no complications after surgery, and the patient's condition improved. Two sets of blood cultures and the aneurysm tissue cultures grew group D Salmonella organisms that were susceptible to ampicillin, cefotaxime, norfloxacin, chloramphenicol, and trimethoprim-sulfamethoxazole.
Of all reported cases of Salmonella aortitis, Salmonella enterica serotype Typhimurium is the most common cause of aortic mycotic aneurysms [1]. Group D Salmonella (non-Typhi) serotypes are a rare cause of aortitis, causing <2.6% of all abdominal aortic aneurysms [2]. In most cases, group D salmonellae were identified in patients with preexisting atherosclerotic disease at the site of an infected aneurysm [3]; this reflects the ability of salmonellae to cause endothelial infection in the presence of artheroclerosis [4]. The majority of cases have involved the infrarenal portion of the abdominal aorta, and the main clinical presentations have been fever and abdominal and/or thoracic pain [1]. Infected abdominal aortitis aneurysms may be complicated by lumbar osteomyelitis (19% of cases), aortoenteric fistula—especially at the third portion of the duodenum—(13%), and psoas abscess (9%) [1].
