Aggregatibacter aphrophilus Bacteremia Associated with Systemic Hemangiomatosis in an Elderly Patient with Ulcerative...

Older patients on biologic therapy for inflammatory bowel disease may be at increased risk for opportunistic infections, reflecting both age-related and immunosuppression-related factors. Aggregatibacter aphrophilus, a HACEK organism, is a rare cause of invasive infection that is typically associated with endovascular disease.

We present the case of a 70-year-old male with ulcerative colitis treated with adalimumab who presented with 4 weeks of fevers, chills, night sweats, and weight loss. CT imaging revealed an intraluminal esophageal lesion and multiple hypodense splenic lesions. Endoscopy demonstrated a vascular-appearing esophageal lesion, and MRI revealed diffuse hemangiomatosis involving the esophagus, spleen, and head and neck musculature. Brain MRI demonstrated a lesion consistent with a septic embolus. Blood cultures grew A. aphrophilus. Applying the 2023 Duke-ISCVID criteria, this case fulfills criteria for possible infective endocarditis. The patient was treated with intravenous ceftriaxone for 4 weeks with clinical improvement. Adalimumab was held after discharge, and ulcerative colitis was subsequently managed with mesalamine with achievement of clinical remission.

Clinicians should be vigilant for complications of immunosuppressive therapy for older patients with inflammatory bowel disease and maintain a broad differential for bacteremia, considering uncommon pathogens such as A. aphrophilus. The esophageal hemangioma precluding transesophageal echocardiography in this case illustrates the diagnostic importance of the 2023 Duke-ISCVID criteria and alternative cardiac imaging modalities in the evaluation of suspected native valve endocarditis when standard approaches are anatomically contraindicated.