IBD and Salmonella Aortitis: A Rare Case Requiring Emergency Intervention
"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).
Rapid Progression and Diagnostic Clues
A reported case documented Salmonella-related arterial-wall necrosis progressing to an abdominal mycotic aneurysm over six days, with computed tomography performed before and after the aneurysm developed (https://link.springer.com/article/10.1007/s003300050108). Another case report described how refractory symptoms, rapid lesion growth, elevated inflammatory markers, and Salmonella bacteremia shifted the diagnostic focus toward infectious aortitis (https://www.jacc.org/doi/10.1016/j.jaccas.2023.101943). These cases illustrate the importance of recognizing rapid vascular change and integrating clinical findings when considering the diagnosis.
The Case: Crohn's Disease, Salmonella Aortitis, and Emergency Treatment
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.
- 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.
ECCO Guidance on IBD Infection Management
The ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease describe advances that have transformed management of Crohn’s disease and ulcerative colitis. The source says these advances enable tighter control of inflammation and significantly improved patient outcomes. The provided excerpt does not specify particular recommendations for Salmonella aortitis.
Rare Disease, High Stakes, and Diagnostic Challenges
Infectious aortitis is described as rare—approximately 3% of aortic aneurysms—but devastating; Salmonella is a common bacterial cause, second to Staphylococcus aureus (https://www.sciencedirect.com/science/article/pii/S266608492300253X). Salmonella gastroenteritis may precede typical presentations that include fever, dyspnea, and chest or abdominal pain. A 2017 report characterizes Salmonella enterica as a rare cause of aortitis and acute aortic syndrome with high mortality risk, emphasizing a high index of suspicion and multidisciplinary, patient-tailored management (https://www.jacc.org/doi/10.1016/S0735-1097(17)35529-8). A 2018 report described what its authors considered the first case of Salmonella aortitis in IBD, successfully managed with antibiotics and emergency endovascular aortic repair.
Reported Causes and Treatment Approaches
One source reports that non-typhoidal Salmonella accounted for 38–42.5% of infected abdominal aortitis cases. Separately, a report on infrarenal Salmonella aortitis notes that endovascular aortic repair has been reported as an alternative to open surgery, while describing the infection as associated with high morbidity and mortality. A 2025 population-based cohort study examined the relationship between non-typhoidal Salmonella infection and risk of inflammatory bowel disease; the supplied excerpt gives no findings from that study. The sources address different questions, so they do not establish a direct comparison between IBD risk and aortitis treatment outcomes.
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.
IBD as an Immune-Response Disorder
The cited review describes inflammatory bowel disease as a group of pathologies resulting from a deregulated immune response that may affect any portion of the gastrointestinal tract. It identifies Crohn’s disease and ulcerative colitis as the most prevalent and defined forms of IBD. The supplied excerpt raises Salmonella infection in its title but does not provide further details about a causal role in IBD onset.
Repair and Follow-Up After Contained Rupture
A reported case of Salmonella aortitis caused a contained rupture of a mycotic infrarenal abdominal aortic aneurysm and was successfully managed with endovascular repair. Follow-up imaging showed a patent graft without endoleak. The case report highlights the association between non-typhoidal Salmonella bacteremia and infectious aortitis, and describes EVAR combined with prolonged antimicrobial therapy as part of management.
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.