CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 60 AFRICA procalcitonin was 0.38 ng/ml, the erythrocyte sedimentation rate (ESR) was 69 mm/h, and there was severe anaemia (haemoglobin: 7.6 g/dl, haematocrit: 23%). The patient was started on empirical antibiotics [intravenous (IV) piperacillin/tazobactam 4.5 g daily, IV vancomycin 1 g once a day] and aortobi-iliac bypass was performed with a dacron graft. Samples for microbiology were taken from the necrotic tissue remnants and abscess in the peri-aortic area. The patient was followed up in the intensive care unit for two days after the operation, and was then transferred to the ward. Gram-negative stained bacteria grew on the pre-operative blood culture samples, and Salmonella enterica grew from the intra-operative samples. The treatment was changed to ceftriaxone 2 g IV, according to the antibiogram. Acute-phase reactant (APR) values r egressed to normal values o n the 17th day postoperatively, and the IV antibiotic treatment was completed in eight weeks. The patient was discharged with ciprofloxacin 2 × 500 mg/day/1 week and acetylsalicylic acid (ASA). In the first month, control CTA showed the aortobi-iliac graft to be patent and not infected (Fig. 2A, B). Case report 2 A 70-year-old male patient was followed in the infectious diseases ward with symptoms of low-back pain, fatigue and fever of unknown origin. The patient was transferred to our service because of signs of inflammation in the peri-aortic area on CTA, blurred edges of the aortic wall, and there was an abdominal aortic aneurysm of 51 mm in its widest part (Fig. 3A, B), compatible with mycotic aneurysm. He stated in his anamnesis that he had had symptoms of coldness, weakness and dry mouth after meals for two months, and that his symptoms had worsened recently. His history included type 2 DM, hypertension, hyperlipidaemia and coronary artery bypass. In the radiological imaging (abdominal ultrasonography and CTA), which was performed two months earlier, the abdominal aortic dimensions and appearance were normal. The patient’s blood pressure was 120/80 mmHg, heart rate was 122 beats/min, oxygen saturation was 98%, and body temperature was 39°C. No abnormality was found in the physical examination except mild pre-tibial oedema (2+). In biochemistry Fig. 2. Repeat CT angiography in the first month after discharge, showing patent aortobi-iliac graft. A B Fig. 3. CT angiography on admission. CTA shows abdominal aortic aneurysm and infected/inflamed aortic aneurysm. A B
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