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Salmonella aortitis should be considered in adults with evidence of salmonella bloodstream infection but no associated GI symptoms

A diagnosis of salmonella aortitis (inflammation of the aorta, the main artery that carries blood from the heart to the body) is an option worth considering in any adult with salmonella infection in the blood, particularly in the absence of associated gastrointestinal symptoms. Researchers, supported in part by the Agency for Healthcare Research and Quality (HS11540), based this conclusion on the case of a 50-year-old man who arrived at a clinical center with fever, chills, and generalized weakness that had lasted for 3 weeks.

The patient had pain and swelling in his right hand and left elbow, weight loss of about 4.5 kg, and occasional pressure in the upper abdominal area. He had not had nausea, vomiting, diarrhea, shortness of breath, or painful or difficult urination. This patient's case was challenging in that several features were absent that might have suggested the correct diagnosis of salmonella aortitis, such as abdominal pain, back pain, and an abnormally high number of white blood cells.

The patient's history of adult-onset Still's disease further complicated the picture. His fever, pattern of inflammation in many joints, enlarged spleen, and higher serum levels of the iron-carrying protein, ferritin, were all typical symptoms of a flareup of adult-onset Still's disease, which can sometimes be triggered by infections.

The case highlights the importance of diligently searching for infection in patients with rheumatic disease before attributing systemic illness to a flareup of the disease, note the researchers. They recommend that, in most cases, treatment of the flareup of rheumatic or autoimmune disease should be delayed until infection has been ruled out. Treatment of salmonella aortitis, unlike autoimmune diseases, usually requires surgery and a prolonged course of antibiotics.

See "Still consider the source," by Amr H. Sawalha, M.D., Sanjay Saint, M.D., M.P.H., Robert W. Ike, M.D., and Michael S. Bronze, M.D., in the October 6, 2005, New England Journal of Medicine 353(14), pp. 1503-1507.

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