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03 November 2019 : Case report  Japan

An Autopsy Case of Rupture of Infectious Thoracic Aortitis Induced by Methicillin-Resistant Staphylococcus Aureus

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Takafumi Goto1ABCDEF, Yasushi Adachi2ABCDEF*, Ryoichi Doi3ABCDE, Koki Kosami45ABCD, Yorika Nakano6BCDE, Kaori Hasegawa1BCD, Mika Wada1BCD, Eri Kobayashi1BCD, Kazuhiro Hirate1BCD, Sigeki Shimizu7DE, Susumu Ikehara8CDE

DOI: 10.12659/AJCR.918892

Am J Case Rep 2019; 20:1612-1618


BACKGROUND: Infectious aortitis has a poor prognosis and high mortality rate if untreated. Here, we report a case of rupture of infectious aortitis induced by methicillin-resistant staphylococcus aureus (MRSA).

CASE REPORT: An 83-year-old female patient was hospitalized due to continuous fever and diarrhea, which was diagnosed as colitis. The colitis was determined to have been induced by small vessel vasculitis upon histological examination. Fasting and central venous hyperalimentation using a peripherally inserted central catheter (PICC) were carried out for rest of the intestine. Swelling and pus were observed at the insertion site of the PICC. Since methicillin resistant staphylococcus aureus (MRSA) was detected in the culture of the pus and the blood, the patient was treated with vancomycin. After confirming that the blood culture became negative, prednisolone (PDL) was started as therapy for the colitis. Her diarrhea and fever improved. After vancomycin was stopped, MRSA-arthritis appeared. She suddenly died due to acute massive hemorrhage into the mediastinum and left thoracic cavity from the atherosclerotic ulcer of the thoracic aorta. It took 98 days from the first detection of MRSA in her blood to her death. We found gram-positive coccus in the ruptured aortic ulcer and we also detected MRSA gene by polymerase chain reaction in the ulcer. These results suggest that MRSA could colonize in the aortic ulcer during the MRSA-bacteremia and the MRSA could contribute to the vulnerability of the aortic wall.

CONCLUSIONS: After septicemia occurrs in an elderly person, the patient should be followed up by considering infectious aortitis, especially when the patient has several risk factors.

Keywords: Aorta, Thoracic, aortic rupture, Aortitis, Autopsy, Bacterial Infections, Methicillin-resistant Staphylococcus aureus, Aged, 80 and over, Anti-Bacterial Agents, Bacteremia, Fatal Outcome, Staphylococcal Infections, Vancomycin



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Am J Case Rep In Press; DOI: 10.12659/AJCR.936896  

16 June 2022 : Case report  Ecuador

Multidrug-Resistant Klebsiella pneumoniae in a Patient with SARS-Cov-2 Pneumonia in an Intensive Care Unit ...

Am J Case Rep In Press; DOI: 10.12659/AJCR.936498  

13 June 2022 : Case report  Japan

Stenotrophomonas maltophilia Infection Associated with COVID-19: A Case Series and Literature Review

Am J Case Rep In Press; DOI: 10.12659/AJCR.936889  

13 June 2022 : Case report  Saudi Arabia

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Am J Case Rep In Press; DOI: 10.12659/AJCR.936128  

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30 Jun 2022 : Case report  China (mainland)

Septic Shock Induced by Acute Pyelonephritis Resulting from Kidney Stones Treated by Double-J Ureteral Sten...

Am J Case Rep In Press; DOI: 10.12659/AJCR.936967  

30 Jun 2022 : Case report  USA

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Am J Case Rep In Press; DOI: 10.12659/AJCR.936896  

29 Jun 2022 : Case report  Kuwait

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Am J Case Rep In Press; DOI: 10.12659/AJCR.936313  

29 Jun 2022 : Case report  USA

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Am J Case Rep In Press; DOI: 10.12659/AJCR.935242  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923