Case Report

Evolving Infectious Aortitis Caused by Streptococcus pneumoniae

Authors: Rekha Goswami, MD, Kerry O. Cleveland, MD, Michael S. Gelfand, MD

Abstract

Infections of major vessels leading to mycotic aneurysms can be a diagnostic dilemma for clinicians, and can be accompanied by a high mortality rate. Successful treatment of this condition often requires a high index of suspicion and prompt medical and surgical attention. The authors report two cases of infectious aortitis caused by pneumococcus that evolved during hospitalization, and discuss diagnostic difficulties that accompany this entity.


Key Points


* Infectious aortitis is difficult to diagnose clinically, and even when the diagnosis is made has a high mortality rate.


* A variety of microorganisms may cause infectious aortitis.


* Symptoms attributable to evolving infectious aortitis may be seen prior to development of frank aortitis, and testicular pain may be an important clue when making a diagnosis.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Maclennan AC, Doyle DL, Sacks SL. Infectious aortitis due to penicillin-resistant Streptococcus pneumoniaeAnn Vasc Surg 1997 Sept;11:533–535.
 
2. Bronze MS, Shirwany A, Corbett C, et al. Infectious aortitis: an uncommon manifestation of infection with Streptococcus pneumoniaeAm J Med 1999 Dec;107:627–630.
 
3. Wilson SE, Van Wagenen P, Passaro Jr E. Arterial infection. Curr Probl Surg 1978;15:1–89.
 
4. Zak FG, Strauss L, Saphra I. Rupture of diseased large arteries in the course of enterobacterial (Salmonella) infection. New Engl J Med 1958;258:824–828.
 
5. Farah I, Giudicelli H, Voirin L, et al. Salmonella aortitis complicated by rupture. Diagnostic and therapeutic problems [in French]. Chirugie. 1993-1994;119:196–199.
 
6. Ewart JM, Burke ML, Bunt TJ. Spontaneous abdominal aortic infections. Essentials of diagnosis and management. Am Surg 1983;49:37–50.
 
7. Woods IV JM, Schellack J, Stewart MT, et al. Mycotic abdominal aortic aneurysm induced by immunotherapy with bacilli Calmette-Guerin vaccine for malignancy. J Vasc Surg 1988;7:808–810.
 
8. Parkhurst GF, Decker JP. Bacterial aortitis and mycotic aneurysm of the aorta: a report of twelve cases. Am J Pathol 1955;31:821–835.
 
9. Sommerville RL, Allen EV, Edwards JE. Bland and infected arteriosclerotic abdominal aortic aneurysms: a clinicopathologic study. Medicine (Baltimore) 1959;38:207–221.
 
10. Revell STR. Primary mycotic aneurysms. Ann Intern Med 1945;22:431–440.
 
11. Bennett DE, Cherry JK. Bacterial infection of aortic aneurysms. A clinicopathologic study. Am J Surg 1967;113:321–326.
 
12. Mendelowitz DS, Ramstedt R, Yao JS, et al. Abdominal aortic salmonellosis. Surgery 1979;85:514–519.
 
13. Bardin JA, Collins GM, Devin JB, et al. Nonaneurysmal suppurative aortitis. Arc Surg 1981;116:954–956.
 
14. Ioannidis JP, Merino F, Drapkin MS, et al. Pneumococcal aortitis in the antibiotic era. Arch Intern Med 1995;155:1678–1680.
 
15. Brouwer RE, van Bockel JH, van Dissel JT. Streptococcus pneumoniae, an emerging pathogen in mycotic aneurysms? Neth J Med 1998;52:16–21.
 
16. Sessa C, Farah I, Voirin L, et al. Infected aneurysms of the infrarenal abdominal aorta: diagnostic criteria and therapeutic strategy. Ann Vasc Surg 1997;11:453–463.
 
17. DeMarco R, Evans JM. An unusual case of testicular pain. Hosp Prac (Off Ed). 1997;32:197, 201.
 
18. Cawthorn SJ, Giddings AE, Taylor RS, et al. Isolated testicular pain: an unrecognized symptom of the leaking aortic aneurysm. Br J Surg 1991;78:886–887.
 
19. O’Keefe KP, Skiendzielewski JJ. Abdominal aortic aneurysm rupture presenting as testicular pain.Ann Emerg Med 1989;18:1096–1098.
 
20. Artman MR, Burkle FM Jr. Acute abdominal aortic aneurysm presenting as isolated testicular pain.Am J Emerg Med 1987;5:45–47.