CRA103 HOARSENESS OF VOICE AS INITIAL PRESENTATION OF SALMONELLA ENTERITIDIS MYCOTIC AORTIC ANEURYSM: A CASE REPORT

Nur Malina binti Mat Reffien, Chee Yik Chang

Hospital Sulatanah Nora Ismail, Batu Pahat. Johor, Malaysia
Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia

Introduction
Salmonella spp. are gram-negative, rod-shaped bacteria that typically cause gastrointestinal infections but can progress to invasive disease such as bacteremia, especially in immunocompromised individuals. One of the serious complications is mycotic aortic aneurysm, which carries high morbidity and mortality. Expansion of the aneurysm may also cause compressive symptoms, such as hoarseness due to recurrent laryngeal nerve involvement.

Case Presentation
We report a case of a 65-year-old man with diabetes mellitus and hypertension who presented with epigastric pain and fever. Blood cultures grew Salmonella Enteritidis, and he was started on intravenous ceftriaxone. On day three of admission, he developed hoarseness of voice. Flexible laryngoscopy revealed left vocal cord palsy, raising suspicion of an aortic aneurysm and prompting a contrast-enhanced CT scan of the neck and thorax. Imaging demonstrated a mycotic aneurysm at the inferior border of the aortic arch, compressing the superior aspect of the main pulmonary artery and causing left vocal cord palsy. The patient was referred to the cardiothoracic team and counseled for Endovascular Aneurysm Repair (EVAR), but he opted for conservative management with antimicrobial therapy. He remained clinically stable with improving inflammatory markers and resolution of hoarseness. The patient completed six weeks of intravenous ceftriaxone and was subsequently discharged home with long-term oral ciprofloxacin suppression therapy.

Conclusion
This case highlights a rare presentation of mycotic aortic aneurysm, manifesting as hoarseness due to left vocal cord palsy from recurrent laryngeal nerve compression. A high index of suspicion is essential, as delayed diagnosis significantly increases the risk of aneurysm rupture and life-threatening complications.