Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. Apr 26, 2022; 12(1): 41-46
Published online Apr 26, 2022. doi: 10.5495/wjcid.v12.i1.41
Unusual cause of hemorrhagic pleural effusion: A case report
Kee Tat Lee, Kar Nim Leong, Ting Soo Chow, Peng Shyan Wong
Kee Tat Lee, Department of Medicine, Hospital Sultanah Bahiyah, Alor Setar 05460, Kedah, Malaysia
Kar Nim Leong, Ting Soo Chow, Peng Shyan Wong, Infectious Disease Unit, Department of Medicine, Hospital Pulau Pinang, Georgetown 10990, Pulau Pinang, Malaysia
Author contributions: Lee KT, Chow TS, and Wong PS were involved in data analysis; Lee KT, Leong KN, Chow TS, and Wong PS contributed to conception of the study and drafting, critically revising, and providing final approval of the manuscript.
Informed consent statement: Written consent for publication has been obtained from the patient.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
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Corresponding author: Kee Tat Lee, MD, MRCP, Doctor, Department of Medicine, Hospital Sultanah Bahiyah, Km6, Jalan Langgar, Alor Setar 05460, Kedah, Malaysia.keetat.lee@gmail.com
Received: January 6, 2022
Peer-review started: January 6, 2022
First decision: February 21, 2022
Revised: March 6, 2022
Accepted: April 3, 2022
Article in press: April 3, 2022
Published online: April 26, 2022
Processing time: 109 Days and 6.8 Hours
Abstract
BACKGROUND

Infected aortic aneurysms are uncommon and difficult to treat. We present a case of infected aortic aneurysm with recurrent nontyphoidal Salmonella bacteremia.

CASE SUMMARY

A 68-year-old gentleman presented with non-specific symptoms and was found to have nontyphoidal Salmonella bacteremia and was treated with intravenous ceftriaxone. However his condition did not improve, and he developed a multiloculated right pleural effusion. Thoracocentesis was done to drain hemorrhagic pleural fluid. Chest computed tomography demonstrated descending thoracic aorta saccular aneurysm with periaortic hematoma likely due to recent bleed and extending to the right pleural cavity. He was referred to cardiothoracic surgery team and was planned for medical therapy in view of hemodynamic stability and no evidence of active leakage. He completed intravenous antibiotic for 5 wk and refused surgical intervention. Unfortunately, he was admitted twice for recurrent nontyphoidal Salmonella bacteremia. Finally, he agreed for surgical intervention and underwent endovascular aortic repair 3 mo later. Postoperatively, his condition remained stable with no recurrence of infection.

CONCLUSION

Our case highlights the importance of high index of suspicion of infected aortic aneurysm in patients with Salmonella bacteremia with high-risk factors such as atherosclerosis.

Keywords: Infected aneurysm; Aorta; Nontyphoidal Salmonella; Pleural effusion; Case report

Core Tip: Infected aortic aneurysm is a rare condition with high mortality. Our aim of this case report is to highlight the importance of high index of suspicion of infected aortic aneurysm in patients with Salmonella bacteremia with additional literature review to help clinician in the management of this disease. Medical therapy alone in this condition is associated with poor outcome.