Thoracic infective native aortic aneurysm and T9–T10 spondylodiscitis complicating recurrent Salmonella enterica bacteremia in a 95-year-old: a case report

Non-typhoidal Salmonella bacteremia in elderly patients is uncommon but carries a high risk of vascular and skeletal complications. Infected native aortic aneurysms are rare and associated with high mortality.

We report the case of a 95-year-old Caucasian man who was admitted after a domestic fall with abdominal discomfort and chills. Blood cultures repeatedly grew Salmonella enterica (full susceptibility). Computed tomography angiography suggested a distal thoracic aortic aneurysm with suspected vertebral involvement. Fludeoxyglucose F18 positron-emission tomography/computed tomography confirmed intense focal uptake of the distal thoracic aortic wall and synchronous uptake at T9–T10 consistent with an infected aortic aneurysm and spondylodiscitis. Transesophageal echocardiography excluded valvular endocarditis and showed a left atrial appendage thrombus. Because surgery was contraindicated due to prohibitive operative risk, the patient received intravenous ceftriaxone (2 g/day) for 10 days followed by oral amoxicillin 2 g three times daily for 6 weeks. Clinical and biological improvement were observed and there was no recurrence during follow-up.

This case highlights the diagnostic utility of positron-emission tomography/computed tomography in recurrent Salmonella bacteremia and supports the role of individualized conservative management in frail elderly patients when surgery is not feasible.