Infected aortic aneurysms presenting with night sweats despite negative blood cultures.

To cite: Nishiguchi S. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014207312 DESCRIPTION A 76-year-old man, an ex-smoker with hypertension, presented to hospital with a 3-week history of continuous night sweats and low-grade fever. Several days after arrival, he developed upper abdominal pain. Body temperature was 36.9°C, blood pressure was 140/88 mm Hg and heart rate was 86 bpm. Physical examination revealed upper abdominal tenderness without defence. Laboratory data showed a white cell count of 9600/mL and an elevated C reactive protein of 4.4 mg/dL. A contrast-enhanced CT scan revealed saccular aneurysms with periaortic infiltration in the descending thoracic and abdominal aorta (figure 1). The patient had undergone intravenous antibiotic therapy for suspected bacterial aortitis despite negative blood cultures. Eighteen days later, CTaortography demonstrated a rapidly enlarging lobulated descending thoracic aneurysm and an abdominal dissecting aortic aneurysm (figures 2 and 3). The patient’s condition and inflammatory markers improved during the treatment period. He was discharged 33 days after admission without surgical intervention. He remains stable 4 months after discharge. An aortic stent graft will be performed due to enlargement of both aortic aneurysms. An infected aortic aneurysm is frequently a fatal disease. A high index of suspicion is required to diagnose infected aortic aneurysms in a patient with a low-grade fever, night sweats and upper abdominal pain and tenderness. Despite negative blood cultures, physicians should consider starting antibiotic treatment as early as possible with the aim to reduce the possibility of aorta rupture.