Fatal Salmonella aortic infection presenting as Stanford type A aortic dissection

Infectious aortitis is a rare but highly lethal condition characterized by rapid destruction of the aortic wall despite, timely surgical and medical treatment. Salmonella species are among the most aggressive causative pathogens. We report a 58-year-old female patient with inflammatory spondyloarthritis who exhibited prolonged fever and systemic inflammatory response, later diagnosed with a Stanford type A aortic dissection. Intraoperative findings revealed a chronic dissection with an adherent and infected-appearing pericardium. Ascending aortic replacement was performed successfully; however, the postoperative course was complicated by recurrent massive mediastinal bleeding requiring repeated surgical re-explorations. While the prosthetic graft remained intact, progressive destruction of the native aortic wall was observed, ultimately necessitating patch repair. Despite prolonged broad-spectrum antimicrobial therapy, systemic inflammation persisted, and the patient died suddenly, most likely due to acute rupture of another infected aortic segment with cardiac tamponade. This case highlights the aggressive and unpredictable nature of Salmonella aortitis and emphasizes that surgical intervention may not prevent fatal outcomes.