Staphylococcal thoracic aortitis complicated by aortic dissection

The diagnosis of aortitis is often delayed as symptoms are largely non-specific. We report a case of Staphylococcal thoracic aortitis in a 73-year-old Chinese woman complicated by aortic dissection. The patient presented with pyrexia of unknown origin, and a contrast enhanced computed tomography aortogram revealed a large thrombus at the anterior aspect of the ascending aorta with two large ulcerations as a result of a chronic type A aortic dissection. A hemiarch replacement with a 28 mm Gleweave Vascutek graft was performed with resuspension of aortic valve commisures. Aortic thrombus cultures were positive for coagulase negative Staphylococcus aureaus, and histology showed chronic dissection of the aorta. The patient was treated with intravenous cefazolin for a 6-week duration and made good progress. This case highlights Staphylococcal infective aortitis complicated by dissection presenting as fever of unknown origin. Timely diagnosis is essential as progression to catastrophic rupture may occur.