Typhimurium para-aortic root abscess managed non-surgically.

INTRODUCTION

Para-aortic root abscess is a destructive vascular condition that can result in significant morbidity and mortality. We describe a rare case of para-aortic root abscess due to Typhimurium that was successfully managed medically.

PRESENTATION OF CASE

A 72-year-old diabetic man with a prosthetic aortic graft presented with fever and expressive aphasia with left sided weakness. Magnetic resonance imaging (MRI) of the brain showed multiple embolic cerebral vascular accidents. Computed tomography angiography (CTA) of the chest showed a 5.7 × 2.7 cm (cm) para-aortic root abscess. Blood cultures grew Typhimurium. The patient was started on ceftriaxone initially, and then ciprofloxacin was added on day 5. Given an unacceptably high risk of mortality expected with surgery, the patient was managed medically.After five months of both ceftriaxone and ciprofloxacin, ceftriaxone was stopped. Twelve months later, the patient is doing well on ciprofloxacin alone with a plan for lifelong suppression.

DISCUSSION

Cases of para-aortic root abscess due to Typhimurium have not been reported in the literature. There are no guidelines to dictate the antibiotic choice or management of para-aortic root abscess due to Typhimurium.

CONCLUSION

This report adds to the body of literature regarding the treatment of this infection including successful non-surgical management.