A patient with infectious aortitis may present with sudden death to massive hemorrhage.

Source of aortic rupture:

(1) aneurysm

(2) dissection

(3) penetrating atherosclerotic ulcer (PAU)


Clinical findings:

(1) history of recent or active infection

(2) persistent fevers

(3) elevated serum C-reactive protein (CRP)

(4) persistent leukocytosis


Organisms involved include:

(1) Staphylococcus aureus

(2) Salmonella species

(3) Clostridium species

(4) Enterococcus species

(5) Streptococcus species

(6) Treponema pallidum (syphilis)


Demonstration of infectious organism:

(1) blood culture

(2) post-mortem culture

(3) histologic exam around the site of rupture or penetration


Reasons for a false-negative culture:

(1) high levels of antibiotics

(2) failure to culture a focus of active infection


Differential diagnosis:

(1) aortitis associated with a rheumatic disease

(2) noninfectious aortic dissection or atherosclerotic aneurysm

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