Abdominal aortitis due to streptococcus pneumoniae and Enterobacter aerogenes: A case report and review

Endovascular infections are 1 cause of fever of unknown origin. We describe a diagnostically challenging case of cryptogenic abdominal aortitis from Streptococcus pneumoniae and Enterobacter aerogenes. A 72-year-old male presented with epigastric pain, fevers, and chills. A computed tomography scan demonstrated enlargement and ulceration of the distal abdominal aorta, prompting urgent vascular surgery. Intraoperative tissue cultures grew S. pneumoniae and E. aerogenes and gatifloxacin was administered for 6 weeks. Spontaneous abdominal aortitis is uncommon and usually due to a single pathogen. This is the second reported case of polymicrobial infectious aortitis and to date, Enterobacter has only been reported in infected aortic grafts. Clinicians should maintain a high index of suspicion for infectious aortitis as the mortality, if only treated medically, approaches 100%.