Infected abdominal aortic aneurysm due to Salmonella in a patient with diabetes mellitus.

We present a case of an elderly patient with uncontrolled diabetes mellitus, who presented with recurrent fever and abdominal pain, after which he was diagnosed with an infected abdominal aortic aneurysm, which represents only 1% of all aneurysms. The patient underwent surgical resection of the aneurysm, rifampicine-impregnated Dacron graft placement and intravenous antibiotic treatment. Microbiology reported Salmonella infection in the aneurysm. Currently, the patient is asymptomatic and without laboratory evidence of inflammatory process.

Presentamos el caso de un paciente de edad avanzada, con diabetes mellitus descompensada, quien presentó un cuadro clínico de fiebre y dolor abdominal recurrente, tras lo cual fue diagnosticado con un aneurisma infeccioso de la aorta abdominal, los cuales representan solamente un 1% de todos los aneurismas. El paciente fue sometido a resección quirúrgica del aneurisma, injerto con dacrón impregnando con rifampicina y tratamiento antibiótico intravenoso. La microbiología del aneurisma confirmó infección por Salmonella. Actualmente, el paciente se encuentra asintomático y sin evidencia laboratorial de proceso inflamatorio.

Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report.

BACKGROUND: Infectious aortic aneurysm, defined as a focal dilation of an infectious arterial wall, is an uncommon life-threatening disease. Compared with open surgery, endovascular repair yields acceptable clinical outcomes. However, residual tissue infection may increase the risk of secondary intervention. Here, we present a successful case of endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm. CASE PRESENTATION: A 58-year-old man presented to hospital with a 3-day history of lower back pain radiating to the back associated with fever. The dynamic imaging characteristics revealed rapid progress of infectious abdominal aortic aneurysm with negative blood culture. The patient underwent endovascular repair and salmonella enteritidis was identified through drain culture. CONCLUSIONS: Endovascular procedure and staged drainage can be feasible and effective option in selected cases.

A mycotic aneurysm related to Salmonella Rissen infection: a case report.

BACKGROUND: Salmonella species commonly causes infection in humans and on occasion leads to serious complications, such as mycotic aneurysms. Here, we present the first case reported of a patient with a mycotic aneurysm likely secondary to Salmonella Rissen infection. CASE PRESENTATION: The patient presented with 4 weeks of lower back pain, chills and a single episode of diarrhoea 2 months prior during a 14-day trip to Hong Kong and Taiwan. Magnetic resonance imaging revealed an aneurysmal left internal iliac artery with adjacent left iliacus rim-enhancing collection. A stool culture was positive for Salmonella Rissen ST 469 EBG 66 on whole genome sequencing. The patient underwent an emergency bifurcated graft of his internal iliac aneurysm and was successfully treated with appropriate antibiotics. CONCLUSIONS: This case highlights the importance of considering the diagnosis of a mycotic aneurysm in an unusual presentation of back pain with features of infection.

Carotid Mycotic Aneurysm associated with Persistent Primitive Hypoglossal Artery. Case Report and Literature Review.

Carotid mycotic aneurysm is extremely rare and even more unusual when it is associated with a persistent primitive hypoglossal artery. This artery is the second most common of the embryonic carotid-vertebrobasilar anastomoses. It originates from the cervical internal carotid artery and enters the cranium through a widened hypoglossal canal before anastomosing with the basilar artery. We report a case of an elderly man with a rare Salmonella-induced mycotic aneurysm associated with a persistent primitive hypoglossal artery. Surgical resection of the mycotic aneurysm was complicated by a posterior circulation stroke. To the best of our knowledge, there was no previous report of a carotid mycotic aneurysm associated with a persistent primitive hypoglossal artery thus far in the literature. Owing to the high mortality rate of the carotid mycotic aneurysm, it is imperative to be familiar with the vascular and imaging anatomy prior to surgery particularly in the presence of an embryonic carotid-vertebrobasilar anastomosis. In this report, we highlight the imaging characteristics and treatment options for this rare mycotic aneurysm together with a literature review.

Non-typhoidal Salmonella aortitis.

Non-typhoidal Salmonella (NTS) spp. causes about 40% of all infective aortitis and it is characterized by high morbidity and mortality. Human infection occurs by fecal-oral transmission through ingestion of contaminated food, milk, or water (inter-human or zoonotic transmission). Approximately 5% of patients with NTS gastroenteritis develop bacteremia and the incidence of extra-intestinal focal infection in NTS bacteremia is about 40%. The organism can reach an extra-intestinal focus through blood dissemination, direct extension from the surrounding organs and direct bacterial inoculation (e.g. invasive medical procedures). Medical and surgical interventions are both needed to successfully control the infection. Here, we report a case of abdominal sub-renal aortitis caused by Salmonella enterica serovar Enteritidis in an 80-year-old man.

Successful total endovascular repair of a giant salmonella-infected painful thoraco-abdominal aortic pseudoaneurysm.

Endovascular approach is now a safe and effective technique for the elective treatment of a thoraco-abdominal aneurysm. This technique has significantly reduced the morbi-mortality for elective surgery. Moreover, it can permit to treat patients with a high surgical risk who are not eligible for open surgery. The permanent availability of endovascular material opens the door for treating a complex emergency thoraco-abdominal aneurysm. Here, we present the case of an 81-year-old man who had a rapidly evolving salmonella-infected aortic thoraco-abdominal Type IV pseudoaneurysm. Total endovascular treatment using aortic endoprosthesis, chimneys for coeliac trunk and superior mesenteric artery and periscopes for renal arteries was performed and permitted to obtain the complete exclusion of the pseudoaneurysm. The patient was event free and discharged from hospital after a few days with an antibiotic treatment adapted for salmonella. He was still event free 10 months after surgery. Endovascular technique might be a viable option even for an emergency infected complex thoraco-abdominal aortic aneurysm. Secondary open surgery should be discussed under the benefit-risk balance.

Unusual Salmonella typhi periprosthetic joint infection involving bilateral knees: management options and literature review.

A 70-year-old Indian woman, who had undergone primary bilateral total knee arthroplasty (TKA) for rheumatoid arthritis 10 months prior, presented with 10 days history of pain, swelling and erythema over both knees with pus discharging from the right knee. She had type 2 diabetes mellitus and was on long-term steroid, leflunomide and antitumour necrosis factor therapy for rheumatoid arthritis. Her clinical and laboratory features were suggestive of a haematogenous periprosthetic joint infection (PJI). The final diagnosis of bilateral Salmonella typhi PJI was made based on culture reports. Considering her underlying immunosuppression, a bilateral two-stage revision TKA was done with complete remission of symptoms and good functional recovery at last follow-up after 18 months. S. typhi infection of prosthetic joint has not been reported in the literature. Patients presenting with gastrointestinal complaints and PJI should alert the clinician to the possibility of infection with such atypical organisms endemic to the region.

Salmonella Thompson splenic abscess in a healthy female.

A 26-year-old woman presented with a 5-day history of fever and 3-day history of left upper quadrant abdominal pain and cough associated with left shoulder tip pain. Initial blood cultures did not display growth. On CT imaging, there was a cyst measuring 7.2×8 cm originally interpreted to be haemorrhagic in nature. Repeat cultures during admission revealed Salmonella Thompson. Percutaneous drainage and antibiotic treatment, rather than splenectomy, was successfully pursued with the patient afebrile and in no pain at 6 weeks follow-up.

A case of a chronic salmonella infection following Roux-en-Y gastric bypass surgery, treated successfully by a laparoscopic cholecystectomy.

We report a case of chronic infection caused by Salmonella and cured by a laparoscopic cholecystectomy after Roux-en-Y gastric bypass (RYGB) surgery for obesity. This patient presented with a 2-year history of chronic abdominal pain, loose stools and excessive weight loss. Her stool and urine cultures were positive for Salmonella Despite multiple courses of antibiotics, she remained positive.After undergoing a laparoscopic cholecystectomy, the patient became asymptomatic and stools remained negative. In chronic carriers for Salmonella, the gall bladder is the common reservoir for the bacteria and removing it is usually curative.The possibility that the source of the may be in the biliary limb of her bariatric procedure and not in the gall bladder remained a concern.In patients who have had a RYGB, cholecystectomy is an effective treatment.All patients presenting with abdominal symptoms following RYGB should have stool and urine cultures taken as part of their work up.

Endovascular Repair of Ruptured Infected Arteries as a Temporizing Measure Versus Destination Therapy.

OBJECTIVE: Mycotic rupture of the arteries is a rare but deadly disorder. Current management typically involves open surgical repair. However, endovascular repair is a potential treatment that can be used to delay open repair, especially in acutely unstable patients. A case report and review of the literature was conducted to determine whether endovascular therapy could be a destination therapy for patients with arterial rupture secondary to infection. METHODS: We present the case of a 72-year-old man with a left common iliac artery aneurysm rupture secondary to Salmonella infection treated with endovascular therapy upon initial presentation. A literature review of PubMed yielded 29 patients with ruptured aortic and iliac infected aneurysms that were initially treated with endovascular repair. RESULTS: Majority of the patients (76.7%, 23 of 30) were successfully treated with the endovascular treatment and did not require open revision. These patients were often placed on long-term antibiotics. CONCLUSION: The literature review supports endovascular repair with a stent graft as a temporizing measure for infected ruptured arteries in an emergent setting and, in select cases, as a destination therapy.

Uncommon Case of Intrapericardial Nontyphoidal Salmonella Infection in a Preterm Baby Presenting As a Cardiac Tumor.

We report a case of an intrapericardial infection resulting from Salmonella Tennessee in a 2-month-old baby, which, upon initial presentation, was masked by a cardiac tumor. The diagnosis was confirmed after successful surgical resection of the mass. Transmission of the infection may have occurred between mother and child in utero, rendering this case extremely unusual.

Autologous Pericardial Reconstruction of Ruptured Salmonella Mycotic Aortic Arch Aneurysm.

The primary goals of surgery for mycotic thoracic aortic aneurysms include control of sepsis, radical debridement of infected tissue, anatomic or extra-anatomic aortic reconstruction, and prevention of recurrent infection. Patients with Salmonella aortitis are a challenging subgroup of patients with aggressive infection and very poor prognosis, because bacterial eradication is difficult and risk of recurrent infection is high. We report the successful surgical management of a patient who presented with a ruptured Salmonella aortic arch aneurysm with extensive debridement and near circumferential autologous pericardial patch reconstruction of the aortic arch.

Splenic abscess due to Salmonella schwarzengrund in a previously healthy individual returning from Bali.

After an episode of diarrhoea, a previously healthy young man developed a splenic abscess due to invasive non-typhoidal Salmonella. The patient was presented with >1 month of fever, diffuse abdominal pain, raised C reactive protein and increased white cell count. Ultrasonography revealed a 5 × 5 cm abscess in the spleen. After an unsuccessful treatment attempt with percutaneous drainage and antibiotics, the patient was successfully treated with splenectomy and antibiotics. This case highlights the difficulties inherent in making a correct diagnosis of splenic abscess in patients without risk factors. Splenic abscess is rare in previously healthy individuals. Antibiotics are inadequate as a sole treatment, and percutaneous drainage is usually only a temporary solution. Splenectomy is still the standard treatment in most cases.