Emphysematous abdominal aortitis: a hint of Salmonella infection
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CE - MEDICAL ILLUSTRATION
Emphysematous abdominal aortitis: a hint of Salmonella infection Wuhong Zheng1,3,4,5 · Yonghuo Ye2 · Haijun Zhou1,3,4,5 Received: 18 August 2020 / Accepted: 9 November 2020 © Società Italiana di Medicina Interna (SIMI) 2020
A 73-year-old man presented to the emergency department with an 18-h fever. He had no nausea, vomiting, diarrhea, cough, expectoration, nor urinary symptoms. Past medical history was remarkable for 10 years of poorly controlled type 2 diabetes. Physical examination was unremarkable except mild percussion pain in the lower back. He presented with sepsis and hyperglycemia (31.13 mmol/L). Blood tests showed a total white blood cell count was 4.52 × 109/L, but the level of procalcitonin (PCT) increased to 50.0 ηg/ ml. 15 h after admission, he complained lumbago and an abdominal computed tomography (CT) was performed which showed that abdominal aorta was surrounded by inflammatory exudation with gas formation (Figs. 1, 2). He was diagnosed with emphysematous abdominal aortitis and was given empirical anti-infection (ertapenem), glycemic control, and organ support treatments. Within 3 days, his temperature returned to normal and lumbago was markedly alleviated. Four days after admission to the hospital, blood cultures grew Salmonella (serogroup D) which was susceptible to ertapenem. As a result, he continued to receive anti-infection with ertapenem. Seven days after admission, the level of Wuhong Zheng and Yonghuo Ye contributed equally to this work.
PCT decreased to 1.14 ηg/ml, but computed tomography angiography (CTA) showed that a large abdominal aortic aneurysm (maximal diameters of 4.1 × 3.2 × 3.6 cm) with mural thrombus was formed. He underwent endovascular stenting. A contrast CTA was performed 14 days after implantation, which showed good stent position and disappearance of the aneurysm. His condition was gradually improved and he was discharged after 26 days of hospitalization. Although Salmonella infection is a common disease, however, Salmonella-associated emphysematous aortitis and its complications are rare and usually life-threatening [1]. Salmonella infection in poorly controlled diabetes patients is the basis of emphysematous aortitis [2]. High concentrations of glucose in the tissues provide a favorable environment for bacteria to produce gas through fermentation, leading to local tissue destruction and sepsis [3]. Abdominal CT and CTA play an important role in early diagnosis and timely identification of complications as well as subsequent therapeutic planning [4, 5]. In summary, this case suggests that, in patients with hyperglycemia who present with fever, lumbago, and sepsis, clinicians should be on high alert for Salmonella-associated emphysematous abdominal aortitis and its potential complications.
* Wuhong Zheng [email protected] 1
Department of Emergency, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, 134 East Street, Fuzhou 350001, Fujian, People’s Republic of China
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