A Case of <i>Salmonella</i>-infected Thoracoabdominal Aortic Aneurysm Making Final Diagnosis Difficult

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  • TOKUNO Osamu
    Clinical Laboratory, Kobe University Hospital
  • KAGAWA Daiki
    Department of Infectious Disease and Internal Medicine, Kobe University Hospital
  • UCHIDA Daisuke
    Department of Infectious Disease and Internal Medicine, Kobe University Hospital
  • KINOSHITA Shouhiro
    Clinical Laboratory, Kobe University Hospital
  • IWATA Kentaro
    Department of Infectious Disease and Internal Medicine, Kobe University Hospital

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Other Title
  • 確定診断に難渋したサルモネラによる感染性胸腹部大動脈瘤の 1 例
  • 症例 確定診断に難渋したサルモネラによる感染性胸腹部大動脈瘤の1例
  • ショウレイ カクテイ シンダン ニ ナンジュウ シタ サルモネラ ニ ヨル カンセンセイ キョウ フクブ ダイ ドウミャクリュウ ノ 1レイ

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Abstract

We report a case of thoracoabdominal aortic aneurysm (TAAA) due to Salmonella Enteritidis making final diagnosis difficult. A 63-year-old man with a history of diabetes mellitus, hypertension, and cerebral infarction was seen elsewhere for a 40℃ fever, vomiting, and shaking on day 1 after onset. He was diagnosed with Salmonella bacteremia and hospitalized by us for intensive care. Computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound imaging did not, however, show critical findings of aneurysm, endocarditis, or osteomyelitis, and laboratory testing suggest significant inflammatory symptoms. He did not respond to antibiotics, but had an intermittent low fever during the first hospitalization. On day 48 after onset during the second hospitalization, abdominal CT showed an aneurysm -3cm in diameter in the thoracoabdominal aorta above the renal artery- small enough to have been missed in earlier diagnosis. Surgery and TAAA graft replacement were done on day 64. Bacterial culture of the graft showed no Salmonella growth due to long-term in vivo antibiotic exposure. He recovered without significant complications, with oral ciprofloxacin antibiotic therapy continued to the present. This case indicates the importance of an early diagnosis through continuous blood culture and imaging for Salmonella sp blood stream infection.

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 85 (3), 280-283, 2011

    The Japanese Association for Infectious Diseases

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