Vertebral osteomyelitis and aortic lesions: case report and review

Abstract

Coexistence of vertebral osteomyelitis and lesions of the aorta is rare but may be lethal if not diagnosed promptly and treated effectively. We describe a patient who was treated at the Cleveland Clinic Hospital, and we review 69 additional cases reported in the literature. The native aorta was involved in 66 cases; four patients developed infection of prosthetic aortic grafts. The most common aortic lesions associated with vertebral osteomyelitis were mycotic aneurysms, infected aneurysms, and pseudoaneurysms. The wide variety of pathogens involved included salmonellae and other gram-negative bacilli, mycobacteria, gram-positive cocci, and fungi. In some cases infection was polymicrobial. The condition was associated with protean clinical manifestations. Diagnosis was frequently delayed, and mortality was 71%. In some instances surgical procedures at sites of unsuspected aneurysms precipitated life-threatening hemorrhage. Therapy with antimicrobial drugs alone was insufficient. The best results were achieved when specific drug therapy was combined with resection of the infected aorta or aortic graft, thorough debridement, and extraanatomic bypass grafting.