When Multiple Conditions Converge: An Unusual Case of Infectious Aortitis in a Patient With Prurigo Nodularis and an...

Infectious aortitis is a rare disease process that presents with mortality varying from 60% to 90%, even with aggressive treatment. This is a case involving a 69-year-old male who initially presented for acute encephalopathy. The patient's past medical history included coronary disease status post coronary bypass graft, abdominal aortic aneurysm status post endograft repair, prurigo nodularis, Tangier's disease, type 2 diabetes mellitus, and stage 3b chronic kidney disease. Initially, the work-up was unrevealing for a cause of the patient's acute encephalopathy. However, astute clinical evaluation led to the diagnosis of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and abdominal infectious aortitis. Prurigo nodularis is a chronic dermatologic condition characterized by the development of intensely pruritic, firm nodules or bumps on the skin associated with itching and scratching. Prurigo nodularis itself does not directly result in bacteremia. However, in rare cases, severe and persistent scratching due to prurigo nodularis can lead to breaks in the skin, creating an entry point for bacteria to spread by the hematogenous route. Certainly, it is highly unusual to have a combination of prurigo nodularis, MSSA bacteremia, and abdominal aortic aneurysm endograft infection. Given the severity of these conditions individually, the combination presents a unique and challenging clinical scenario that requires prompt and coordinated management by a multidisciplinary team. This case report aims to provide new insights into the potential risk factors, clinical course, and management strategies for these combined conditions.