Thoracic infective native aortic aneurysm and T9-T10 spondylodiscitis complicating recurrent Salmonella enterica bacteremia in a 95-year-old: a case report.

BACKGROUND: Non-typhoidal Salmonella bacteremia in elderly patients is uncommon but carries a high risk of vascular and skeletal complications. Infected native aortic aneurysms are rare and associated with high mortality.

CASE PRESENTATION: We report the case of a 95-year-old Caucasian man who was admitted after a domestic fall with abdominal discomfort and chills. Blood cultures repeatedly grew Salmonella enterica (full susceptibility). Computed tomography angiography suggested a distal thoracic aortic aneurysm with suspected vertebral involvement. Fludeoxyglucose F18 positron-emission tomography/computed tomography confirmed intense focal uptake of the distal thoracic aortic wall and synchronous uptake at T9-T10 consistent with an infected aortic aneurysm and spondylodiscitis. Transesophageal echocardiography excluded valvular endocarditis and showed a left atrial appendage thrombus. Because surgery was contraindicated due to prohibitive operative risk, the patient received intravenous ceftriaxone (2 g/day) for 10 days followed by oral amoxicillin 2 g three times daily for 6 weeks. Clinical and biological improvement were observed and there was no recurrence during follow-up.

CONCLUSION: This case highlights the diagnostic utility of positron-emission tomography/computed tomography in recurrent Salmonella bacteremia and supports the role of individualized conservative management in frail elderly patients when surgery is not feasible.