Escherichia coli-Induced Aortitis and Aortic Perforation: A Case Study and Literature Review

BACKGROUND Inflammation of the aorta is a potentially life-threatening condition. Infectious aortitis has been associated with various pathogens, although Escherichia coli has rarely been implicated. CASE REPORT We describe an 82-year-old man with a past medical history of diabetes mellitus type II and ischemic heart disease, who presented with a 2-week history of back and abdominal pain. Imaging revealed aortitis with a periaortic fluid collection, from which E. coli was isolated. The patient underwent urgent endovascular aneurysm repair (EVAR) and was treated with 4 weeks of intravenous cefuroxime followed by prolonged oral antibiotics, with normalization of inflammatory markers. Four months later he was readmitted because of septic shock and a large periaortic abscess was diagnosed. He required open drainage and aortic repair and died of complications. We review the literature of 33 cases involving E. coli aortitis, including the present case, of whom the mean age was 69±11, 26 (79%) were male, 31 (94%) were diagnosed by computed tomography (CT) scan, and 27/31 (87%) received surgical intervention. Further, 25 out of 30 patients (83%) for whom all data regarding interventions and survival were available, survived. CONCLUSIONS Aortitis due to E.coli is a potentially fatal infection. Treatment consists preferably of a combination of prolonged intravenous antibiotics - for at least 6 to 12 weeks - and a surgical intervention. If possible, the patient should undergo EVAR, and if not, open corrective surgery, which is associated with a survival rate of 83%.