European Heart Journal Advance Access originally published online on April 7, 2006
European Heart Journal 2006 27(17):2068; doi:10.1093/eurheartj/ehi847
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Staphylococcal aortitis
1 Intensive Care Unit, Cardiology Hospital
2 Emergency Department, University Hospital
3 Radiology Department, Cardiology Hospital
4 Anatomopathology Laboratory, University Hospital
* Corresponding author. E-mail address: ennezat{at}yahoo.com
A 78-year-old woman was hospitalized for paraparesis. She had no past medical history. Ten days before admission, the patient complained of severe chest pain. Five days before admission, she complained of dysuria with abdominal pain with constipation and experienced difficulties in walking. Blood pressure was 110/40 mmHg and heart rate was 70 bpm. Temperature was 38.6°C. Cardiopulmonary examination was unremarkable. Abdomen was diffusely tender. Bowel sounds were present. There was no rebound or guarding. Neurological examination revealed confusion and paraparesis without sensitive deficiency or pyramidal syndrome. Abnormal laboratory tests were white blood count 18.1 g/L, fibrinogen 9.6 g/L, C-reactive protein 364 mg/L, procalcitonin 192.5 pg/L, and serum alanine and aspartate aminotransferase levels were 170 and 126 UI/L, respectively. Blood and cerebrospinal fluid cultures grew meticillin-sensitive Staphylococcus aureus. There was a marked dilatation of the descending aorta on chest X-rays (white arrows). Chest CT scan with contrast revealed a false aneurysm of the descending aorta and a small pleural bilateral effusion. Abdomen CT scan showed hypodensity of the left renal cortical parenchyma and no evidence of bowel ischaemia. Brain CT scan was unremarkable. A trans-oesophageal echocardiogram confirmed the diagnosis of pseudo-aneurysm resulting from a perforating ulcer. A serpentine thrombus straddled the orifice (red arrow). Cardiac valves were normal. Hospital course was complicated by acute renal failure and uncontrollable sepsis. Despite the intensive care therapy and effective antibiotic therapy, patient expired. A purulent aneurysm for the descending aorta with a necrotic aortic wall was found at autopsy that did not include the brain. Multiple septic microembolisms were noted in the adrenal glands and left cortical kidney. In conclusion, diagnosis of aortitis should be considered in patients with atherosclerosis, fever, chest, and abdominal pain. Prognosis remains severe concerning the risk of septic shock and aneurysm rupture.
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