The pneumococcus remains in the antibiotic era a formidable pathogen, capable of atypical, lethal clinical presentations. We report two fatal cases of thoracic aortitis caused by Streptococcus pneumoniae in the setting of bacteremic illness from this pathogen. One case occurred in an aortic graft and the other arose in a native aorta. We also discuss the indolent clinical presentation and the diagnostic failure of transesophageal echocardiography and leukocyte scintigraphy. Persistent pyrexia with atypical chest pain and unexplained blood loss should alert clinicians to the possibility of this uncommon, yet lethal complication of pneumococcal disease
(Arch Intern Med. 1995;155:1678-1680)