CASE REPORT: Aortitis from the Unusual Culprit of S. pneumoniae, Serotype 23B

Introduction: Aortitis is a rare but potentially life-threatening condition involving inflammation of the aortic wall that may lead to aneurysm formation or rupture. Infectious aortitis caused by Streptococcus pneumoniae is an uncommon but severe entity associated with high morbidity and mortality. Case Presentation: We report a case involving a Caucasian female in her 60s who presented with fever and severe left-sided flank pain. Initial laboratory work revealed leukocytosis and elevated inflammatory markers. Imaging identified a rapidly expanding aneurysm of the descending thoracic aorta with intramural thrombus formation. Blood cultures confirmed S. pneumoniae bacteremia, specifically serotype 23B, a strain not covered by current pneumococcal vaccines. The patient was managed with targeted antimicrobial therapy and underwent thoracic endovascular aortic repair (TEVAR) due to aneurysm progression. Conclusions A follow-up PET-CT scan one year later confirmed the resolution of the infection. Early imaging, multidisciplinary management, and tailored antimicrobial therapy are essential for optimizing patient outcomes in cases of infectious aortitis.