Acute aortic dissection in sepsis with Staphylococcus bacteraemia

Abstract

© BMJ Publishing Group Limited 2021. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION Acute aortic dissection is a clinical emergency. The most common causes are uncontrolled hypertension and atherosclerosis. We present a case of an acute aortic dissection diagnosed following persistent Staphylococcus aureus bacteraemia sepsis. A 98yearold woman was transferred to hospital after an unwitnessed fall at her aged care facility and was found to be febrile on arrival. Relevant medical history included previous stroke without significant neurologic deficit, hypertension and congestive heart failure. Medications included verapamil slowrelease 240 mg two times per day, perindopril 5 mg in morning, indapamide 2.5 mg in morning, frusemide 20 mg in morning and pravastatin 20 mg at night. She was a nonsmoker and ambulated well with a fourwheel frame. On presentation to the emergency department, she denied chest pain or presyncope. Her only localising infective symptom was a productive cough for 1 week and mild lower abdominal pain without dysuria. On examination, her blood pressure was 130/60 mm Hg and heart rate 80 bpm. She had left basal inspiratory chest crepitations and mild suprapubic tenderness. There was no focal neurology. Initial inflammatory markers included Creactive protein 324 mg/L and white cell count 12.8×10/L. Her chest Xray Figure 1 CT abdomen and pelvis performed on admission with portovenous phase contrast (A) axial image at T8 level and (B) sagittal image of a heavily atherosclerotic thoracic aorta but no surrounding collection.