LAUSR

Infectious aortitis (IA) is a rare, high-mortality condition. The differential diagnosis is challenging, as up to 50% of IA cases present with negative cultures. This article aims to describe the findings of a case study in which a patient had developed aortitis due to Neisseria gonorrhoea. In the literature, there are only three previous reports of gonococcal IA, and this case has a very different evolution. A 33-year-old man presented with fever (lasting 45 days), chills, chest pain and weight loss. He had a past history of rheumatic fever (on regular prophylaxis) and an aortic-valve replacement surgery in 2002 (bioprosthesis). Physical examination revealed: 38.4 C, hepatomegaly, a previously observed 5/6 systolic aortic murmur and a new 1/6 diastolic aortic murmur. Laboratory data: leukocytosis, C-reactive protein (CRP) 195.2 mg/L, microscopic Gram stain examination with Gramnegative diplococci, and aerobic blood culture positive for N. gonorrhoea (repeated three times after a previous negative culture). Tests for syphilis, human immunodeficiency virus and other sexually transmitted infection serologies were negative. No clinical or laboratorial features indicated how the patient acquired gonorrhoea. Transthoracic and transoesophageal echocardiography showed no vegetations. Positron emission tomography–computed tomography (PET/CT) with F-FDG, which was conducted to investigate the aetiology of the bacteraemia, revealed a