Aortic stent infection in etiology of fever of unknown origin in a geriatric patient

Objective: Aortic stent greft infections (ASGI) are associated with significant morbidity and mortality. ASGI may exist as a seldom cause of fever. Case report: A 67 year-old male patient presented with fever, fatigue, chest pain and night sweats for a week. He had no infection sign except 3/6 systolic murmur. He admitted to the clinic with a prediagnosis of infective endocarditis. Combination therapy with ceftriaxon (2 g/day) + vancomycine (2 g/day) was administered. No vegetation was seen on neither transthoracic nor transesophageal ecocardiography. Methicillin-sensitive Staphylococcus aureus (MSSA) yielded in blood cultures. Antibiotherapy was changed to sulbactam-ampicilline (8 g/day). Then, we learned that the patient has an aortic stent placed due to aortic dissection. Contrast enhancement was detected in magnetic resonance imaging. Cardiovascular surgeons decided not to remove the stent because of increased mortality; therefore antimicrobial therapy was extended to 4 weeks. But soon after discharge from the hospital, the patient re-admitted with fever. Sulbactam-ampicilline was begun, and MSSA yielded in blood cultures again. Antibiotherapy was continued for an additional 6 weeks. No recurrent infection occurred during 6 months of follow-up. Conclusion: ASGI could be one of the causes of fever of unknown origin (FUO). Despite the recommended treatment of ASGI being surgery, long-term conservative antimicrobial treatment may be performed successfully in patients with high surgical risk. © 2012 Asian Pacific Tropical Medicine Press