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一例罕见的非伤寒沙门菌败血症导致危及生命的主动脉炎病例。

An Unusual Case of Non-typhoidal Salmonella Bacteremia Causing Life-Threatening Aortitis.

作者信息

Ansari Fawwad A, Gafoor Stefan, Aftab Mubashira, Nlandu Zola

机构信息

Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA.

Internal Medicine, Fazaia Medical College, Islamabad, PAK.

出版信息

Cureus. 2024 Feb 21;16(2):e54645. doi: 10.7759/cureus.54645. eCollection 2024 Feb.

Abstract

Non-typhoidal typically presents with gastroenteritis. However, an invasive infection, which may be typically seen in immunocompromised patients, has a propensity for aortic involvement, especially in patients with risk factors for atherosclerosis. Here we present a 60-year-old female with multiple comorbid conditions and currently on immunosuppressants for rheumatoid arthritis, who presented with nausea, vomiting, and fever of three weeks duration and was found to have bacteremia. Blood cultures were positive for . Computed tomography (CT) abdomen with contrast was concerning for mycotic aortitis. The patient underwent endovascular repair of an aortic ulcer and was treated with a six-week course of ceftriaxone. Mycotic aneurysm is a rare but potentially fatal complication of invasive infection. It occurs typically in older men with atherosclerotic risk factors. It mostly presents as fever, back pain, and/or abdominal pain. Our patient was a middle-aged female who presented with non-specific symptoms. CT angiogram is the diagnostic modality of choice and treatment may require surgical vascular repair and long-term antibiotics. A high level of suspicion is needed to diagnose  mycotic aneurysm/aortitis. Early diagnosis and treatment may improve the mortality.

摘要

非伤寒型通常表现为肠胃炎。然而,侵袭性感染在免疫功能低下的患者中较为常见,有累及主动脉的倾向,尤其是在有动脉粥样硬化危险因素的患者中。在此,我们报告一名60岁女性,患有多种合并症,目前因类风湿关节炎正在服用免疫抑制剂,出现了持续三周的恶心、呕吐和发热症状,被发现患有菌血症。血培养结果显示 呈阳性。腹部增强计算机断层扫描(CT)提示霉菌性主动脉炎。该患者接受了主动脉溃疡的血管内修复,并接受了为期六周的头孢曲松治疗。霉菌性动脉瘤是侵袭性 感染的一种罕见但可能致命的并发症。它通常发生在有动脉粥样硬化危险因素的老年男性中。主要表现为发热、背痛和/或腹痛。我们的患者是一名中年女性,表现出非特异性症状。CT血管造影是首选的诊断方法,治疗可能需要进行血管外科修复和长期使用抗生素。诊断霉菌性动脉瘤/主动脉炎需要高度怀疑。早期诊断和治疗可能会降低死亡率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3e91/10959711/0e784bc9181d/cureus-0016-00000054645-i01.jpg

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