Management of aortic brucellosis with infection of a descending thoracic aortic stent graft

Abstract

A 74-year-old Iranian-born man initially presented with a penetrating atherosclerotic ulcer of the descending thoracic aorta. He underwent endovascular stenting of the lesion, but later presented with recurrent back pain and fever. He was then diagnosed with brucellosis and started on antimicrobial therapy, including 2 weeks of parenteral gentamicin and two oral agents that were poorly tolerated. Two years later he presented with fever, recurrent back pain, and new hemoptysis. He underwent successful resection of the descending thoracic aorta with in situ interposition graft reinforced with an omental wrap. Ten months postoperatively, the patient remains on lifelong suppressive antimicrobial therapy with ciprofloxacin and rifampin, without any sign of infection. No similar case has been previously reported in the English literature.