Aortoesophageal fistula as a late-onset complication of infected aortic arch aneurysm caused by Salmonella enterica serotype Choleraesuis: a case report

BACKGROUND: Salmonella enterica serotype Choleraesuis (S. Choleraesuis) is a nontyphoidal Salmonella serotype that can cause foodborne illness in a broad range of animals. In healthy individuals, S. Choleraesuis infections most often cause self-limiting acute gastroenteritis. However, more serious infections can develop and be associated with high mortality in immunocompromised patients. CASE PRESENTATION: We report a 71-year-old male patient who presented to the emergency department with a 3-week history of fever and chest discomfort. Chest computed tomography revealed an infected aortic aneurysm in the distal aortic arch with an infected hematoma in the mediastinum. S. Choleraesuis was identified in both the blood cultures on admission and the hematoma specimen culture obtained from the surgical mediastinal drainage. Despite appropriate antimicrobial therapy with thoracic endovascular aortic repair and surgical mediastinal drainage, the patient died of massive hematemesis due to an aortoesophageal fistula. CONCLUSIONS: S. Choleraesuis tends to invade the bloodstream, leading to bacteremia and infected aortic aneurysms. Aortoesophageal fistula is a rare but life-threatening cause of upper gastrointestinal bleeding that may be due to an infected aortic aneurysm. To save the patient’s life, further studies on the proper management of infected aortic arch aneurysms complicated with aortoesophageal fistulas are needed. CLINICAL TRIAL NUMBER: Not applicable.