Rationale: Mycotic aortic aneurysm (MAA) is uncommon, accounting for 1%-3% of all aortic aneurysms. Delayed treatment carries a high risk of rapid enlargement, rupture, and death. MAA may spread contiguously from an abdominal aortic source to the adjacent vertebrae and psoas, resulting in spondylodiscitis and psoas abscess. MAA is an uncommon but life-threatening condition. The simultaneous presentation of an MAA with both spondylodiscitis and an iliopsoas abscess (IPA) represents an exceedingly rare and fatal triad of complications from invasive non-typhoidal Salmonella infection. Patient concerns: A 59-year-old male presented with progressive low back pain and intermittent fever for about 6 six weeks. Imaging revealed multiple infrarenal mycotic aortic aneurysms, an L3-L4 spondylodiscitis, and extensive bilateral IPAs. Blood and abscess cultures identified Salmonella group D1. Diagnosis: Salmonellosis associated with mycotic aortic aneurysm. Intervention: The endovascular stent-graft repair was implanted combined parenteral antibiotics, with initial clinical improvement after surgical debridement for abscess. Outcome: He represented with recurrent Salmonella bacteremia three months later and subsequently expired. Lessons: Physician must keep a high index of suspicion for an underlying MAA in patients presenting with spondylodiscitis or IPA. It tragically illustrates the significant risk of treatment failure with endovascular stent-graft repair, emphasizing that rigorous long-term surveillance is essential for patients managed with this approach.
Lee et al. (Fri,) studied this question.