11 January 2026
: Case report 
Complex Aorto-Spinal Fistula With Multifocal Abscesses in an Immunosuppressed Elderly Man Following Endovascular Aortic Repair
Unknown etiology, Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare coexistence of disease or pathology
Adam Henderson
EF 1, Mohamed G. Ibrahim ABEF 2, Mario El Hayek ABEF 2, Margaret E. McKinney ABD 3, Jesse W. St Clair IV ABD 4*
DOI: 10.12659/AJCR.949903
Am J Case Rep 2026; 27:e949903
Table 1 Timeline of major events and interventions of patient case.
| Time from EVAR | Event | Intervention |
|---|---|---|
| 0 months | Initial surgery for asymptomatic infrarenal AAA (8.6×9.6 cm) | EVAR placement |
| +1 month | Type 1b endoleak of right common iliac artery diagnosed | Endoleak repair with stenting |
| +1 month (post-endoleak repair) | Progressive back and hip pain, intermittent fevers, elevated inflammatory markers. Patient had multiple emergency department visits during the next several months due to pain, including one brief admission | Polymyalgia rheumatica misdiagnosed. Prednisone initiated at 35 mg, later increased to 60 mg. Sarilumab added every 2 weeks |
| +6 months | Outside hospital MRI: L4–L5 discitis/osteomyelities, large anterior epidural abscess, bilateral psoas abscesses | Laminectomy and abscess evaluation; IV vancomycin + aztreonam initiated. Switched to vancomycin + rifampin after cultures returned positive for MSSA and . Repeat imaging showed new fluid collection |
| +7 months | Left prior hospital and immediately presented to our facility with severe pain. CT showed posterior epidural collection, aorto-disc space fistula, multiple muscle abscesses | Patient initiated on IV daptomycin 8 mg/kg daily for six weeks. Epidural drain placement with Interventional Radiology; cultures from drain eventually positive for . EVAR explant with aortobiiliac reconstruction with rifampin-soaked Dacron grafts; surgical debridement; psoas drainage; antibiotic beads (vancomycin, gentamicin, daptomycin) in L4 disc space |
| +8 months | Patient improved. Rheumatology ruled out polymyalgia rheumatica; steroids tapered and sarilumab discontinued | Continued on IV daptomycin for 6 weeks and discharged to skilled rehab facility |