Escherichia coli primary aortitis presenting as sequelae of incompletely treated urinary tract infection

Johnstone, Jill K.; Garcia-Toca, Manuel; Slaiby, Jeffery M.; Marcaccio, Edward J.; Chong, Tze Tec

doi:10.1016/j.jvs.2011.12.074

Cited by 5 publications

(2 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nonetheless, we cannot ignore the presence of an E. coli urinary tract infection concomitantly presenting with abdominal aortitis. E. coli is not typically a common cause of aortitis; however, one case report of primary aortitis has been reported as sequelae of an incompletely treated urinary tract infection [11]. This case had a similar history interval of three weeks, but that patient predominantly presented with fever, chills, and abdominal pain; he required an axillofemoral bypass with resection of the infected aorta along with a six-week course of intravenous antibiotics highlighting the severity of most infective aortitis cases.…”

Section: Discussionmentioning

confidence: 86%

Isolated Abdominal Aortitis Following a Urinary Tract Infection

Mustafa¹,

Weilg²,

Young³

et al. 2021

Cureus

View full text Add to dashboard Cite

A 49-year-old female with a history of sporadic episodes of scleritis was initially seen by her primary care physician (PCP) due to a two-day history of cramping abdominal pain, new elevated high blood pressure, increased urinary frequency, and urgency. The patient was diagnosed with an acute cystitis supported by a positive urine culture for a pan sensitive Escherichia coli; however, after two courses of antibiotics as an outpatient, her blood pressure (BP) remained markedly elevated, and her abdominal pain got worse which prompted a computed tomography (CT) abdomen and pelvis with contrast revealing inflammatory changes consistent with aortitis. The diagnosis was supported by a magnetic resonance angiography (MRA) which showed wall thickening and enhancement extending for approximately 4.8 cm involving the abdominal aortic wall just prior to the bifurcation. An extensive work up including CTA, US doppler of four-limbs, and fluorodeoxyglucose (FDG)-positron emission tomography (PET) confirmed the isolated abdominal aortitis. After infectious etiologies were ruled out, the patient was started on prednisone 60 mg daily which resulted in marked improvement of her symptoms. After a four-month taper of steroids, the patient had complete resolution of her symptoms, with no signs of recurrence.

show abstract

Section: Discussionmentioning

confidence: 86%

Isolated Abdominal Aortitis Following a Urinary Tract Infection

Mustafa¹,

Weilg²,

Young³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…Other case reports describing this clinical entity also describe this similar presentation. [12][13][14][15] The rarity of this condition and the non-specific presentation in our patients likely contributed to the length of time between presentation and operation and the need for additional imaging. Only 1 patient presented in straightforward fashion with positive blood cultures and a CTA demonstrating a large periaortic inflammatory process with abscess.…”

Section: Discussionmentioning

confidence: 91%

Management and Outcome of Non-Aneurysmal Primary Aortic Infection

Kumins

Wogsland

Smith

et al. 2022

Vasc Endovascular Surg

View full text Add to dashboard Cite

Introduction Aortic infection without prior intervention or aneurysm is exceedingly rare. We report the presentation, diagnosis, management, and outcome of patients with this unusual entity. Methods Retrospective chart and imaging review of patients with primary aortic infection. Results 5 patients (3 male, mean age 71.2 years) presented between 2014 and 2022. All had abdominal, back, or flank pain. Four had constitutional symptoms. All were evaluated with a complete blood count; 3 had leukocytosis. Both serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were elevated in the 4 patients evaluated with these tests. All were studied with peripheral blood culture on the first hospital day prior to any antibiotic administration. Blood culture was positive in only 1 patient. Computed tomography (CT) scan showed periaortic inflammation without aneurysm in all. Fluorodeoxyglucose positron emission tomography (PET) was obtained in 3 and a radiolabeled leukocyte single-photon emission CT (SPECT) scan was performed in 2. All demonstrated periaortic concentration of the radioisotope consistent with inflammation or infection. Intraoperative cultures were positive in 3. One patient who had a negative intraoperative culture was examined with broad range polymerase chain reaction (PCR) and DNA sequencing which identified a causative bacterium. The other patient with a negative intraoperative culture had periaortic abscess but was on antibiotics preoperatively, potentially confounding the culture. All patients underwent in-situ repair with rifampin impregnated polyester (N = 2), cryopreserved aortic allograft (N = 2), or autogenous femoral vein (N = 1). No patient developed recurrent infection or aortic related complications following surgery with an average follow up of 31.8 months (range 8-88 months). Conclusions Patients with primary aortic infection present similarly with the triad of abdominal or back pain, laboratory markers of infection, and imaging demonstrating periaortic inflammation. Patients were treated successfully with in-situ repair. Preoperative identification of a causative organism was difficult, and PCR may be useful to help identify an organism.

show abstract