Bartonella-Associated Thoracic Endograft Infection with Aorto-Esophageal Fistula: A Case Report

Abstract Introduction While Bartonella is a well-established cause of infective endocarditis, there are few reports of other endovascular manifestations of Bartonella infections. Case description A 75-year-old woman with a history of thoracic aortic aneurysm status post thoracic endovascular aortic repair (TEVAR) two years prior presented with subacute back pain, fever, and malaise, and was found to have an infected thoracic endograft complicated by aorto-oesophageal fistula. Transthoracic and transoesophageal echocardiography did not reveal evidence of endocarditis. She was started on broad-spectrum antimicrobial therapy and underwent complex surgical management including graft explantation and oesophageal stenting. Molecular analysis of the TEVAR explant detected mixed oropharyngeal flora as well as Bartonella species. The serological pattern was most consistent with prior or ongoing B. henselae infection, although it did not establish the species identity of the organism detected in the operative specimen. Despite surgical management and targeted antimicrobial therapy, her clinical course progressively deteriorated, and she ultimately transitioned to comfort care. Discussion To our knowledge, as of a literature search completed 8 April 2026, this is the first reported detection of Bartonella spp. in an infected endograft in a patient with an aorto-oesophageal fistula and underscores the importance of considering fastidious and uncommon pathogens in culture-negative or polymicrobial aortic graft infections.