Interconnectedness of gut microbiome, aorta, and immune system dysregulation in IBD.

IBD and Salmonella Aortitis: A Rare Case Requiring Emergency Intervention

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"Uncovering the Link Between Immunosuppression, Salmonella Infection, and Aortic Inflammation in a Crohn's Disease Patient."

Infectious aortitis, an inflammatory condition affecting the aortic wall, is typically triggered by microorganisms and can lead to aneurysm formation. It's a rare condition, accounting for less than 1% of all aortic aneurysms, but carries a high mortality rate if not promptly detected and treated.

Among the various microbes implicated in aortitis, Salmonella stands out, particularly Salmonella aortitis, a less common form of the infection that arises from a gram-negative motile enterobacteria. This type of bacteria is known to cause enteric fever, osteomyelitis, and meningitis, and can also affect the coronary arteries, thoracic and abdominal aorta, prosthetic valves and grafts.

Patients with inflammatory bowel disease (IBD) share similar risk factors for Salmonella aortitis with the general population, including pre-existing atherosclerosis, advanced age, myelodysplastic syndrome, and rheumatoid arthritis. This article delves into a unique case of Salmonella aortitis in a patient with IBD, successfully managed through antibiotics and emergency endovascular aortic repair (EVAR).

The Case: Crohn's Disease, Salmonella Aortitis, and Emergency Treatment

Interconnectedness of gut microbiome, aorta, and immune system dysregulation in IBD.

A 49-year-old woman with a 20-year history of Crohn's disease, who was being treated with adalimumab, presented with fever (38.5°C), left flank and mid-back pain, diarrhea, and vomiting one week after returning from Bolivia. This case underscores the importance of considering infectious complications in immunocompromised individuals, especially those with a history of travel to regions with endemic diseases.

Upon examination, the patient had an anovaginal fistula and had previously undergone a subtotal colectomy with ileorectal anastomosis. Routine lab tests revealed mild neutrophilia (12 x 106/L) and significantly elevated calprotectin (CRP, 231mg/L).

Initial Treatment and Diagnosis: Intravenous antibiotics were immediately started while awaiting the results of blood, urine and stool cultures.
Culture Results: Stool cultures came back negative; however, blood cultures tested positive for Salmonella enteritidis, which was sensitive to ceftriaxone.
Clinical Deterioration: Despite treatment, the patient experienced persistent pyrexia and worsening CRP (330mg/L). Abdominal CT scans with contrast revealed features of aortitis (Fig. 1), which had increased in size on a follow-up CT scan performed eight days later.

The patient was immediately transferred to a specialized center for emergency endovascular repair. Currently, she is on long-term antibiotics, and adalimumab was recommenced 21 months later. The patient is now doing well on follow-up.

Early Detection and Intervention: Key to Survival

Disseminated enteric infections in patients with IBD on immunosuppressive therapy, although rare, must be considered. Clinicians should maintain a high index of suspicion in immunosuppressed patients presenting with fever, abdominal pain, or other signs of infection, especially in those who have recently traveled to regions with endemic diseases.

This case illustrates the importance of early diagnosis, prompt intervention, and improved chances of survival for patients with Salmonella aortitis. Rapid identification and treatment of this rare condition can significantly impact patient outcomes.

Healthcare providers must ensure vigilance when treating patients with IBD, especially when they are on immunosuppressive therapy and have traveled to regions with higher rates of infection. The success of this case hinged on the prompt recognition of the condition, swift intervention, and a multidisciplinary approach to treatment.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/ibd/izy347, Alternate LINK

Title: A Case Of Ibd Immunosuppression Related Salmonella Aortitis Requiring Emergency Vascular Grafting

Subject: Gastroenterology

Journal: Inflammatory Bowel Diseases

Publisher: Oxford University Press (OUP)

Authors: Abdulmaleek Idanesimhe Sado, Rahul Kalla, Abishek Sharma

Published: 2018-11-05

Everything You Need To Know

What is infectious aortitis and why is it important in the context of this case?

Infectious aortitis is an inflammatory condition affecting the aortic wall, typically caused by microorganisms. It can lead to the formation of aneurysms, which are life-threatening. In the context provided, Salmonella aortitis is a specific type of infectious aortitis caused by the bacteria Salmonella. This type of aortitis is particularly dangerous due to its potential to cause aortic aneurysms and its high mortality rate if not treated promptly. The case highlights the importance of early detection and intervention in immunocompromised individuals.

What is Salmonella aortitis and what are the implications of this diagnosis?

Salmonella aortitis is a rare but serious condition where the aorta, the main artery carrying blood from the heart, becomes inflamed due to a Salmonella infection. The condition arises from a gram-negative motile enterobacteria. Salmonella aortitis is less common but more concerning because it can lead to aortic aneurysms. The implications of this diagnosis include the need for immediate medical intervention, such as antibiotics and potentially emergency endovascular aortic repair (EVAR), to prevent rupture of the aorta, which is often fatal.

How does Crohn's disease contribute to the risk of Salmonella aortitis?

Crohn's disease is a type of inflammatory bowel disease (IBD) that causes chronic inflammation of the gastrointestinal tract. Patients with IBD, like the patient in the case, are often treated with immunosuppressive therapies, such as adalimumab. This treatment makes them more susceptible to infections, including Salmonella. The significance here is that the immunosuppression associated with IBD treatments increases the risk of developing severe infections like Salmonella aortitis, underscoring the need for careful monitoring and prompt treatment when infections occur.

What is the role of emergency endovascular aortic repair (EVAR) in the treatment described?

Emergency endovascular aortic repair (EVAR) is a surgical procedure used to repair aneurysms in the aorta. In the context of this case, it was a crucial intervention used to save the patient's life. It involves inserting a stent graft into the aorta to reinforce the weakened vessel wall, preventing rupture. The fact that the patient required EVAR demonstrates the severity of Salmonella aortitis and the need for timely and specialized medical care to manage the complications arising from it.

Why is immunosuppression a critical factor in this case, and what are the implications?

Immunosuppression, as seen in the case with adalimumab, weakens the immune system, making individuals more vulnerable to infections. In this scenario, the patient with Crohn's disease being treated with adalimumab was at higher risk for severe complications from the Salmonella infection. This context shows that patients taking immunosuppressants must be closely monitored for infections, especially when they travel to regions where diseases like Salmonella are endemic. The implications include considering the risks of immunosuppression when managing IBD and the importance of quickly treating any signs of infection in these patients to prevent life-threatening outcomes.