P1986 - Nontyphoidal Salmonella Bacteremia Causing Mycotic Aneurysms and Subsequent Vascular Graft Infection: A Case Report

Bernard Dankyi, MD¹, Sandi Dunn, MD², Zainab Saeed, MD³, Mehak Sachdeva, MBBS³, Aneta tarasiuk-Rusek, MD^3
1University of Central Florida, HCA Healthcare GME, Ocala, FL; ²HCA Florida Healthcare, Ocala, FL; ³HCA Healthcare, Ocala, FL

Introduction: Salmonella infections can rarely cause mycotic aortic aneurysms, which can be fatal if undiagnosed and consequently untreated. Symptoms including fever, chills, chest pain or back pain. We describe a patient who presented to the emergency department complaining of recurrence of severe abdominal pain after recent abdominal aortic aneurysm grafting. Further work-up revealed Salmonella bacteremia with Salmonella.

Case Description/Methods: A 41-year-old female with no history presented to the hospital for an abnormal CT. She had unrelenting abdominal pain for about 3 months and progressively getting worse. There was no specific trigger for the pain, and was described as a belt-like pressure. Patient has a 36 pack year smoking history. She had a right iliac aneurysm and an Aortic aneurysm on abdominal CT. Surgery was consulted and patient had a graft placed( fig. 1). She was discharged with some medication to control the pain. 2 weeks after the graft was placed patient returned to the ED with severe abdominal pain worse than before graft placement. Patients labs showed lactic acid of 4.8, Na 133, and K 3.3, AST 39, ALT 53, Alk Phos 314, WBC 27, and vitals showed temp 97.6 HR 119 RR 20 BP 102/65. Patient was admitted under sepsis criteria and on IV fluids, blood cultures, urine sample were acquired and patient was started on broad spectrum antibiotics vancomycin and cefepime. CTA abdomen and pelvis showed findings most characteristic of aortitis. Findings were worrisome for an infected aortic aneurysm which extended down into the right iliac artery. Blood cultures were positive for salmonella group C/D sensitive to Ceftriaxone.

Discussion: Salmonella normally enters the body through the ingestion of contaminated food sources or via iatrogenic modes such as surgery. The patient's symptoms, along with chest and back pain, are documented symptoms of salmonella infections leading to aneurysms (Guo et al., 2018). Non-typhoidal Salmonella-caused mycotic aneurysms are extremely rare. Further conversation revealed the patient had an episode of diarrhea about a month before symptoms of abdominal pain started. Patient has since then had night sweats, chills rigors and generalized fatigue but she associated it with her work. Patient and her significant other are in contact with deli products and had a cookout prior to the diarrhea episode. Blood cultures should be obtained to rule out salmonella bacteremia prior to surgical treatment of the aneurysm to prevent complications as in this patient.



Disclosures:


Bernard Dankyi, MD¹, Sandi Dunn, MD², Zainab Saeed, MD³, Mehak Sachdeva, MBBS³, Aneta tarasiuk-Rusek, MD³. P1986 - Nontyphoidal <i>Salmonella</i> Bacteremia Causing Mycotic Aneurysms and Subsequent Vascular Graft Infection: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.