SHM Converge Scientific Abstract ePoster Gallery-A Case of Presumed Strep Pneumoniae Aortitis

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A 70-year-old man with CAD, hypertension, and hyperlipidemia presented with two months of weight loss, nausea, and worsening lower abdominal pain radiating to the back. CT angiogram showed abnormal soft tissue enhancement around the infrarenal abdominal aorta, raising concern for aortitis. He did not meet SIRS criteria, but inflammatory markers were elevated, so blood cultures were obtained and empiric antibiotics started.<br /><br />The differential included infectious, rheumatologic, and malignant causes. Rheumatologic testing was negative, and biopsy was not feasible. Rapid blood culture PCR was positive for Streptococcus pneumoniae, and later cultures confirmed pneumococcal bacteremia. Despite an extensive search, no infection source was identified.<br /><br />On hospital day 10, worsening abdominal pain and rising inflammatory markers prompted repeat imaging, which revealed a penetrating atherosclerotic ulcer of the infrarenal aorta, a form of acute aortic syndrome. Vascular surgery was consulted, and the patient underwent endovascular aortic repair (EVAR) on hospital day 11. He was discharged in stable condition on hospital day 22 with plans for six weeks of IV ceftriaxone.<br /><br />The case emphasizes that infectious aortitis is an uncommon but serious cause of abdominal pain and may present without classic sepsis features. Blood cultures can be critical when tissue diagnosis is unavailable. Infectious aortitis can progress rapidly to aneurysm or ulceration, so early vascular surgery involvement, serial abdominal exams, and repeat imaging are important.

Asset Subtitle

Evan L. Bale

Meta Tag

Author List Evan L. Bale, Matthew Wofford

Category Clinical Vignettes

Concept Infectious Aortitis

Concept Blood Culture

Concept Polymerase Chain Reaction

Concept Abdominal Pain

Concept Systemic Symptoms

Distinguished Non-Finalist

Presenter Organization University of Colorado Department of Hospital Medicine

Presenting Author Evan L. Bale

Track Adult

Keywords

infectious aortitis

Streptococcus pneumoniae

pneumococcal bacteremia

abdominal pain

infrarenal aorta

penetrating atherosclerotic ulcer

endovascular aortic repair

CT angiogram

blood cultures

IV ceftriaxone

Infectious Aortitis

Blood Culture

Polymerase Chain Reaction

Abdominal Pain

Systemic Symptoms