An expanding abdominal aorta ulcer as a rare complication of Staphylococcus aureus sepsis in a hemodialysis patient: A case report.

BACKGROUND: End-stage renal disease patients on maintenance hemodialysis are at high risk of severe infections. The co-occurrence of methicillin-sensitive Staphylococcus aureus septicemia and penetrating aortic ulcer in this population is rare, posing notable therapeutic challenges. METHODS: A case of a 73-year-old male end-stage renal disease hemodialysis patient was analyzed. The patient presented with left flank pain, nausea, and anorexia. Diagnoses and treatment adjustments were based on laboratory tests, computed tomography angiography, and serial monitoring of biomarkers and imaging. RESULTS: Laboratory tests showed severe inflammation (white blood cell: 23.95 × 10⁹/L; C-reactive protein: 196.06 mg/L; procalcitonin: 21.15 ng/mL) and methicillin-sensitive S. aureus bacteremia. computed tomography angiography revealed abdominal aortic ulcer with bilateral renal artery stenosis. Initial meropenem/linezolid was switched to vancomycin post-culture; further adjustment to piperacillin-tazobactam/moxifloxacin followed ulcer progression. The patient refused surgery, received conservative treatment, and had Candida albicans superinfection on hospital day 20 (treated with fluconazole). He was discharged with reduced inflammatory markers and resolved symptoms, but follow-up showed ulcer expansion with hematoma (high rupture risk). CONCLUSION: Aortic infections in dialysis patients are therapeutically challenging. Serial biomarker monitoring and imaging are crucial for detecting disease progression, even with improved clinical symptoms.