Acute infectious aortitis presenting as pyelonephritis.

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Radiology

Background:

• Infectious aortitis is a rare, life-threatening condition often presenting as sepsis.
• Risk factors include male sex, age over 50, diabetes mellitus, and peripheral vascular atherosclerotic disease.
• Early recognition is vital for timely intervention and improved patient outcomes.

Observation:

• A 65-year-old male with type 2 diabetes presented with sepsis, fever, abdominal pain, and pyuria.
• Initial CT revealed infra-renal aortic infiltration; subsequent Aortic CT angiography identified a pseudo-aneurysm.
• PET-CT confirmed abnormal 18F-FDG uptake, indicative of active inflammation adjacent to the aorta.

Findings:

• The patient was diagnosed with infectious aortitis complicated by an aortic pseudo-aneurysm.
• Abdominal aortic reconstruction using a cryopreserved arterial allograft was successfully performed.
• The case highlights the diagnostic utility of multimodal imaging in suspected infectious aortitis.

Implications:

• Infectious aortitis should be considered in septic patients with vascular risk factors and suggestive imaging findings.
• Prompt contrast-enhanced CT angiography and PET-CT are essential for accurate diagnosis.
• Multidisciplinary management involving vascular surgery and early antibiotic therapy is critical for favorable outcomes.