Case Presentation:
A 54 year‐old woman presented with 4 days of sharp epigastric pain that radiated to her back. She reported a recent upper respiratory tract infection that resolved prior to admission. She was febrile to 100.6 F, tachycardic, and had epigastric tenderness on exam. A complete blood count, chemistries, liver function tests and lipase were normal. Right upper quadrant ultrasound was unremarkable, and the patient was admitted to rule out myocardial infarction. Due to persistent fever, a CT scan of the abdomen and pelvis was obtained and revealed inflammatory stranding between the distal esophagus and descending aorta concerning for aortitis. Inflammatory markers including ESR and CRP were markedly elevated. CT angiogram of the chest was notable for a 2.5 cm long shallow irregular ulcer in the distal thoracic aorta in the area of aortitis. Five days later CT angiogram of the torso demonstrated progression of the inflammation and two focal pseudoanuerysms. Blood cultures grewHaemophilus Influenza and an echocardiogram was unremarkable. The patient underwent endovascular repair of the thoracic aneurysm with a rifampin soaked graft and was treated with 6 weeks of intravenous ceftriaxone for Haemophilus influenza aortitis.
Discussion:
Haemophilius influenza is rare cause of infectious aortitis, with few reported cases in the literature. Infectious aortitis is rare in the antibiotic era; most cases are noninfectious in etiology and commonly associated with the large vessel vasculitides. The most common pathogens associated with infective aortitis include Staphylococcus, Enterococcus, and Streptococcus species, which predominantly affect the thoracic aorta, and Salmonella which more often affects the abdominal aorta. Most reported cases of Haemophilius influenza aortitis involve the abdominal aorta. Infectious aortitis may develop from bacteremic seeding of the aorta, endocarditis with septic embolization, or direct inoculation of the pathogen from trauma. This patient likely had Haemophlius influenza presenting as odynophagia with resultant seeding from the oropharynx to the aorta. The clinical manifestations of infectious aortitis include fever, and abdominal pain. CT or MR angiography are the initial recommended diagnostic imaging. An echocardiogram should also be performed to rule out endocarditis as the source of infection. Infectious aortitis carries a high rate of aortic rupture and mortality if left untreated. Broad‐spectrum intravenous antibiotics should be initiated at diagnosis, and tailored based on culture data. The standard surgical management is resection of the infected aortic segment, although endovascular aortic repair is also performed.
Conclusions:
Hospitalists should recognize infectious aortitis as a cause of abdominal pain and fever, which is fatal if diagnosis and treatment are delayed.