SHM Converge Scientific Abstract ePoster Gallery-Clear Cultures, Cloudy Diagnosis: A Perivascular Salmonella Trap

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This case describes an 83-year-old man with hypertension, chronic urinary retention, recurrent UTIs, and a bladder stone who presented with 3 weeks of progressive suprapubic pain. He had leukocytosis, mild kidney injury, and sterile pyuria. CT imaging revealed a right internal iliac artery pseudoaneurysm with an adjacent fluid collection. Blood cultures grew pan-susceptible <em>E. coli</em> and <em>Salmonella enterica</em>, and he was started on ceftriaxone with vascular intervention including coil embolization and stent graft placement.

Despite initial treatment and clearance of repeat blood cultures, the patient clinically worsened: his pain became more focal in the right lower pelvis/inguinal region, his WBC rose further, and repeat CT showed enlargement of the perivascular collection. Because persistent inflammation and worsening pain suggested an ongoing deep infectious nidus, interventional radiology drained the collection. Aspirate culture grew non-typhoidal <em>Salmonella enterica</em>, confirming a peri-pseudoaneurysmal abscess.

He improved after drainage and continued ceftriaxone, with a planned 6-week course and long-term levofloxacin suppression because of retained vascular hardware. The case highlights that non-typhoidal <em>Salmonella</em> can seed vascular structures hematogenously, causing arteritis, pseudoaneurysm, and deep endovascular infection. Negative repeat blood cultures do not rule out persistent infection when symptoms, leukocytosis, or imaging worsen.

The key clinical lesson is to assess the patient, not just the cultures: worsening focal pain and enlarging collections should prompt repeat imaging and early multidisciplinary involvement of infectious disease, interventional radiology, and vascular surgery for source control.

Asset Subtitle

Ahmed S. Rehman

Meta Tag

Author List Ahmed S. Rehman, Chase S. Robinson, Philip K. Angelides

Category Clinical Vignettes

Concept Non-typhoidal Salmonella

Concept Endovascular infection

Concept Source Control

Concept Bacteremia

Concept Mycotic aneurysm

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Ahmed S. Rehman

Track Adult

Keywords

Salmonella enterica

pseudoaneurysm

internal iliac artery

perivascular abscess

vascular infection

E. coli bacteremia

ceftriaxone

coil embolization

stent graft

source control

Non-typhoidal Salmonella

Endovascular infection

Source Control

Bacteremia

Mycotic aneurysm