Critical Care: Student/Resident Case Report Poster - Critical Care I |

Emphysematous Aortitis Caused by Clostridium Septicum Bacteremia FREE TO VIEW

Joseph Geffen, MPH; Avinash Ramdass, MD; Faisal Mohammed, MD; Vandana Seeram, MD
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University of Florida, Jacksonville, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):380A. doi:10.1016/j.chest.2016.08.393
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SESSION TITLE: Student/Resident Case Report Poster - Critical Care I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Emphysematous aortitis is a rare vascular complication of anaerobic bacterial infections and has high mortality rates if untreated.

CASE PRESENTATION: A 75-year-old male with a history of type 2 diabetes and hypertension presented from his primary care physician’s office after complaints of fatigue, vague non-radiating, intermittent chest pain and poor appetite. Examination on admission revealed an afebrile man without tachypnea or tachycardia and an otherwise normal cardiac examination with symmetric distal pulses. A chest radiograph demonstrated a widened mediastinum followed by a CT angiogram which showed significant aortic wall inflammation from the left subclavian artery and extending down the descending aorta with associated emphysematous aortitis (Figure 1). Blood cultures were positive for Clostridium septicum for which he was started on piperacillin/tazobactam and beta-blockade for blood pressure control. Further imaging showed diverticulosis and diffuse colitis. He was treated conservatively with IV antibiotics and his bacteremia resolved with dramatic improvement in the emphysematous aortitis (Figure 2) He was discharged on antibiotics with plans for open surgical repair when antibiotic therapy was completed.

DISCUSSION:Clostridium septicum aortic infection is a potentially lethal disease that carries an overall 6-month mortality of 64% and a 100% mortality rate for patients who do not undergo operative intervention (1). C. septicum aortitis is usually related to an underlying malignancy and patients typically present septic. In patients for whom there is radiographic evidence of an aortitis with positive blood cultures, mycotic aortitis should be suspected, and prompt empiric antibiotics should be commenced followed by surgical resection and aortic repair (2). Patients who are poor surgical candidates may be treated alternatively with endovascular aneurysm repair as a destination therapy if they have a limited expected lifespan or as a bridging therapy to open surgery (3).

CONCLUSIONS:Clostridium septicum aortitis is a rare and life-threatening infection and can rapidly lead to aneurysmal aortic changes. Seeding of the aorta is thought to occur from bacterial seeding to atheromatous lesions. Standard treatments include effective antibiotic therapy, excision with appropriate debridement, and reconstruction or endovascular stent grafts.

Reference #1: Seder CW, Kramer M, et al Clostridium septicum aortitis: Report of two cases and review of the literature. J Vasc Surg 2009;49:1304-9

Reference #2: Wu HY, Kan CD. Images in cardiovascular medicine: Emphysematous aortitis. Circulation 2010; 122:e413

Reference #3: Yu SY, Lee CH, Hsieh HC, et al. Treatment of primary infected aortic aneurysm without aortic resection. J Vasc Surg 2012; 56:943-950

DISCLOSURE: The following authors have nothing to disclose: Joseph Geffen, Avinash Ramdass, Faisal Mohammed, Vandana Seeram

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