Salmonella Aortitis Related to Rheumatoid Arthritis

A 65-year-old woman with a history of rheumatoid arthritis on immunosuppression with methotrexate and etanercept presented with abdominal pain, fever, and diarrhea. Symptoms initially improved with a short course of oral ciprofloxacin but soon recurred. Computed tomography imaging of the abdomen was concerning for intramural abscess, aortitis, and a 3.8-cm aneurysm. She was initiated on broad-spectrum antibiotics and underwent emergent endovascular repair and graft. Blood and intraoperative cultures remained negative. After completing 6 weeks of broad-spectrum antibiotics, she had recurrence of symptoms, with blood cultures showing Salmonella species, requiring explant of hardware and a surgical bypass. She had several subsequent morbidities, including iatrogenic chylous leak, and Clostridium difficile colitis, and ultimately died. A high degree of suspicion is needed for a timely diagnosis of infectious aortitis in patients with compatible findings. Despite optimal therapy, infectious aortitis continues to have significant morbidity and mortality.