EC Clinical and Medical Case Reports

Introduction: Emphysematous aortitis is a rare and potentially fatal form of infectious aortitis characterized by the presence of gas within the aortic wall, often due to gas-producing pathogens. Immunocompromised patients, including those with HIV, are particularly susceptible.

Case Presentation: We report the case of a 42-year-old HIV-positive male presenting with acute chest and back pain, fever, and hypotension. Laboratory results revealed elevated inflammatory markers and leukocytosis. Contrast-enhanced CT demonstrated circumferential thickening of the descending thoracic aorta with multiple foci of intramural gas and periaortic soft tissue stranding, consistent with emphysematous aortitis. Blood cultures identified Clostridium perfringens.

Intervention and Outcome: The patient underwent emergency surgical debridement with in situ aortic graft placement and received broad-spectrum intravenous antibiotics. Postoperative recovery was initially complicated by systemic inflammatory response, but follow-up imaging demonstrated resolution of the infection. He remained stable under long-term suppressive antibiotic therapy.

Conclusion: This case highlights the importance of early cross-sectional imaging for prompt diagnosis and management of emphysematous aortitis in immunocompromised patients. Multidisciplinary care is essential to prevent catastrophic outcomes, particularly in high-risk populations.

Keywords: Aortic Infection; Clostridium perfringens; CT Imaging; Emphysematous Aortitis; Gas-Forming Organisms; HIV; Immunocompromised Host; Infectious Aortitis; Mycotic Aneurysm; Vascular Infection

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