Pneumococcal aortitis: A rare but severe and often undiagnosed vascular complication

Streptococcus pneumoniae aortitis is an uncommon manifestation of invasive pneumococcal disease, characterized by inflammation and destruction of the aortic wall, often leading to mycotic aneurysm formation. This entity remains largely underdiagnosed and poses significant diagnostic and therapeutic challenges. We conduct a systematic review of 94 published cases from 1945 to 2025 after the report of three cases of pneumococcal aortitis diagnosed at our institution between 2023 and 2024. Risk factors, clinical presentation, diagnostic modalities, microbiologic confirmation, and treatment strategies are analyzed. We emphasize the diagnostic contribution of molecular techniques, such as 16S PCR and metagenomic next-generation sequencing (mNGS), particularly in the frequent culture-negative setting. Despite advances in management, pneumococcal aortitis remains associated with substantial morbidity and mortality. Timely recognition and multidisciplinary care are essential.