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Pneumococcal aortitis in the antibiotic era

J P Ioannidis1, F Merino, M S Drapkin

  • 1Division of Geographic Medicine and Infectious Diseases, New England Medical Center Hospitals, Boston, Mass, USA.

Archives of Internal Medicine
|August 7, 1995
PubMed

Insights

Streptococcus pneumoniae can cause fatal thoracic aortitis, even with antibiotic treatment. This rare complication affects both native and grafted aortas, often presenting subtly.

Area of Science:

  • Infectious Diseases
  • Cardiovascular Medicine
  • Pathogen Research

Background:

  • Streptococcus pneumoniae is a significant pathogen during the antibiotic era.
  • Atypical and lethal presentations of pneumococcal infections are well-documented.
  • Thoracic aortitis is a rare but severe vascular complication.

Observation:

  • Two fatal cases of thoracic aortitis caused by Streptococcus pneumoniae bacteremia are presented.
  • One case involved an aortic graft, while the other affected a native aorta.
  • The clinical presentation was indolent, with diagnostic challenges.

Findings:

  • Transesophageal echocardiography and leukocyte scintigraphy failed to diagnose the aortitis in both cases.
  • The pathogen identified was Streptococcus pneumoniae, leading to fatal thoracic aortitis.
  • The complication occurred in both prosthetic and native aortic tissues.

Implications:

  • Clinicians should consider thoracic aortitis as a rare complication of pneumococcal disease.
  • Persistent fever, atypical chest pain, and unexplained bleeding warrant investigation for this condition.
  • Early recognition and diagnosis are crucial for managing this lethal complication of pneumococcal infections.

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