1. Low back pain, fever and chills for one week
EMphoto-22
Low back pain, fever and chills for one week
戴德森醫療財團法人嘉義基督教醫院急診部
陳泓安、蔡銘仁
※ Chief Complaint：
Low back pain, fever and chills for one week.
※ Present Illness：
This 58-year-old man with type II diabetes, coronary artery disease post percutaneous coronary intervention, hypertension, hyperlipidemia presented with low back pain, fever and chills for one week. He denied recent trauma, radiation pain, stool or urine incontinence, or hematuria.
※ Physical Examination：
Abdomen: soft without tenderness, muscle guarding, and rebounding pain.
Extremities: freely movable.
Straight leg raise test: negative.
※ Laboratory Examination：
WBC: 15990/ul, Seg: 91.5%.
CRP: 20.95mg/dl, ESR: 74. GLU: 436mg/dl
Urine analysis: no pyuria.
Blood culture: Salmonella group C
※ Imaging：
※ Question：
What is the diagnosis of this patient?
※ Answer：
Infected aortitis complicated with psoas muscle abscess and infectious spondylitis.
※ Discussion：
Infected aortitis, a rare disease, most affects patients with atherosclerotic aortic disease, immunocompromised status, and/or infective endocarditis. Mycotic aneurysm is the most common form of presentation. Salmonella species and Staphylococcus aureus are the leading frequent pathogens because of their characteristics of tending to adhere and incubate on the atherosclerotic plaque. Early diagnosis of this disease is difficult but important because it is potentially life-threatening. However, its clinical manifestations are often non-specific, depending on the site of infection and aneurysm formation. Fever, thoracic, back and abdominal pain, and chills are the most frequent symptoms. Computed tomography with contrast enhancement is a widely available tool to diagnose this disease. The treatment usually includes surgical excision of the infected aorta in combination with broad-spectrum antibiotics.
※ Take Home Points：
1. Physician should keep infected aortitis (or mycotic aneurysm) in mind especially in patients with atherosclerotic risk factors and immunocompromised status, like old age, diabetes and with prosthetic arterial devices presenting with unknown cause of fever and back pain.
2. In patients with unknown cause of Salmonella species or Staphylococcus aureus bacteremia, infected aortitis (or mycotic aneurysm) should be considered.