A 37-Year-Old Woman with Abdominal Pain and Aortic Dilatation

This case report describes a 37-year-old woman with abdominal pain and progressive aortic dilatation. Initial non-contrast CT revealed infrarenal aortic wall thickening with periaortic fat stranding, which advanced to aneurysmal enlargement and luminal irregularity despite steroid therapy. Her history included injection drug use, hepatitis C, and systemic symptoms. Differential diagnosis included infectious aortitis and large-vessel vasculitis, particularly Takayasu’s arteritis. Blood cultures later confirmed methicillin-resistant Staphylococcus aureus (MRSA). She underwent urgent endograft placement followed by explantation and homograft reconstruction. Histopathology revealed florid acute and chronic inflammation with gram-positive cocci clusters, confirming active graft infection. Her treatment included vancomycin, ceftaroline, and rifampin, followed by oral suppressive therapy. The case illustrates diagnostic complexities between infectious and autoimmune aortic pathology and highlights surgical and antimicrobial strategies for MRSA-infected vascular grafts.

This case report describes a 37-year-old woman with abdominal pain and progressive aortic dilatation. Initial non-contrast CT revealed infrarenal aortic wall thickening with periaortic fat stranding, which advanced to aneurysmal enlargement and luminal irregularity despite steroid therapy. Her history included injection drug use, hepatitis C, and systemic symptoms. Differential diagnosis included infectious aortitis and large-vessel vasculitis, particularly Takayasu’s arteritis. Blood cultures later confirmed methicillin-resistant Staphylococcus aureus (MRSA). She underwent urgent endograft placement followed by explantation and homograft reconstruction. Histopathology revealed florid acute and chronic inflammation with gram-positive cocci clusters, confirming active graft infection. Her treatment included vancomycin, ceftaroline, and rifampin, followed by oral suppressive therapy. The case illustrates diagnostic complexities between infectious and autoimmune aortic pathology and highlights surgical and antimicrobial strategies for MRSA-infected vascular grafts.