Mycotic aortic aneurysm associated with salmonellosis presenting as a fatal triad of aortitis, spondylodiscitis, and iliopsoas abscess: A case report

Abstract

Rationale: Mycotic aortic aneurysm (MAA) is uncommon, accounting for 1%-3% of all aortic aneurysms. Delayed treatment carries a high risk of rapid enlargement, rupture, and death. MAA may spread contiguously from an abdominal aortic source to the adjacent vertebrae and psoas, resulting in spondylodiscitis and psoas abscess. MAA is an uncommon but life-threatening condition. The simultaneous presentation of an MAA with both spondylodiscitis and an iliopsoas abscess (IPA) represents an exceedingly rare and fatal triad of complications from invasive non-typhoidal Salmonella infection.

Patient concerns: A 59-year-old male presented with progressive low back pain and intermittent fever for about 6 six weeks. Imaging revealed multiple infrarenal mycotic aortic aneurysms, an L3-L4 spondylodiscitis, and extensive bilateral IPAs. Blood and abscess cultures identified Salmonella group D1.

Diagnosis: Salmonellosis associated with mycotic aortic aneurysm.

Intervention: The endovascular stent-graft repair was implanted combined parenteral antibiotics, with initial clinical improvement after surgical debridement for abscess.

Outcome: He represented with recurrent Salmonella bacteremia three months later and subsequently expired.

Lessons: Physician must keep a high index of suspicion for an underlying MAA in patients presenting with spondylodiscitis or IPA. It tragically illustrates the significant risk of treatment failure with endovascular stent-graft repair, emphasizing that rigorous long-term surveillance is essential for patients managed with this approach.

Keywords

Aortitis / Iliopsoas abscess / Mycotic aortic aneurysm / Spondylodiscitis

Conflict of interest statement

All authors have no competing of interest to declare.

Ethical approval

The institutional review board (IRB) of Taichung Veterans General Hospital approved this study on 12 Sep 2024 (The study period ranged from 12 Sep 2024 to 11 Sep 2025) (IRB file number: CE24414B).

Consent for publication

Patient’s written informed consent for publication was waived as the data were fully anonymized and analyzed retrospectively in accordance with institutional and national research.

Funding

This work was supported by grants from the Taichung Veterans General Hospital (TCVGH), Taichung, Taiwan (TCVGH-T1127801, TCVGH-1137203C, and TCVGHT1137801). The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.

Data availability

All data generated or analyzed relating to this study are presented within this published article.

Authors’ contributions

Conceptualization, LL, SYH; Funding acquisition, SYH; Investigation, LL, SYH, CLT, and TCC; Supervision, SYH and TCC; Validation, SYH and CLT; Writing—original draft, LL and SYH; Writing—review and editing SYH and TCC. All authors contributed to the article and approved the submitted version. All authors have read and agreed to the published version of the manuscript.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Edited by Pan Y, Lei Y, Zhang Q

Acknowledgements

The authors would like to thank all the staff of the intensive care unit to take care this patient.

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