A sixty-five-year-old woman was admitted to the hospital complaining of weight loss and melena. She had a history of five vascular operations including aortobifemoral bypass. During hospitalization, she developed sepsis with Streptococcus milleri bacteremia. A computed tomographic scan and gastroduodenoscopy suggested aortoduodenal fistula, which was confirmed by surgical exploration. An echocardiogram showed mitral valve vegetation. This case suggests the potential role of Streptococcus milleri bacteremia and endocarditis in the pathogenesis of aortoduodenal fistula.
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