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Yuan SM, Yuan AH. Mycotic subclavian artery aneurysms: a scoping review. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2023; 19:303-310. [PMID: 38187490 PMCID: PMC10767570 DOI: 10.5114/aic.2023.133235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/27/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Mycotic subclavian artery aneurysms (SAAs) are a very rare disorder. Aim To provide an overview of current knowledge on clinical features, management strategies and outcome evaluations of mycotic SAAs. Material and methods The study materials were based on comprehensive literature retrieval of publications of mycotic SAAs published between 2000 and 2023. Results Contaminated mechanical injuries and abscess erosions of the arterial walls are mechanisms of mycotic SAAs. The diagnosis relies on detection of pathogenic microorganisms by cultures or microbiological investigations of blood, other fluids and infected tissues as well as medical imaging visualization. The indications for an interventional therapy were poor general condition, high surgical risk, and rescue exclusion for a ruptured pseudoaneurysm. Three (9.1%) pre-treatment deaths were a result of sudden rupture of the mycotic SAAs and thus they lost the opportunity of treatment. All post-treatment deaths occurred in the interventional patient group, whereas the causes of death seemed to be unrelated to mycotic SAAs per se or to treatments of choice. Patient outcome evaluations revealed no significant difference between different treatments of choice. No significant predictive risk factors were responsible for patient outcomes. Conclusions Once a diagnosis of mycotic SAA is made, sensitive antibacterial drugs are applied immediately to control the infection and control aneurysmal progression. Early treatment is conducted as soon as possible to avoid aneurysmal rupture. A decision on treatment of choice is made based on the patient's specific condition. Antibacterial drug use is continued for about 6 weeks after surgical or interventional therapy.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, China
| | - Ai-Hong Yuan
- Department of Anesthesiology (2017), the First Clinical College, China Medical University, Shenyang, Liaoning Province, China
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2
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Sasaki H, Numata Y, Kamiya S, Sone Y, Sasaki O. An Escherichia coli-Induced Distal Arch Aneurysm Presenting With Hemoptysis. Cureus 2023; 15:e40654. [PMID: 37476141 PMCID: PMC10356179 DOI: 10.7759/cureus.40654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Infected thoracic aneurysms are a rare and potentially life-threatening condition that present with non-specific symptoms. We describe here a case of an 83-year-old female who presented to the emergency department with the chief complaint of vomiting blood. The patient had presented to the emergency department 40 days earlier with abdominal pain, fever, and leukocytosis. She had a medical history of traumatic liver injury resulting in bile duct stenosis, necessitating percutaneous transhepatic gallbladder drainage and subsequent bile duct-jejunal anastomosis 25 years ago. Emergency contrast-enhanced computed tomography (CT) revealed an irregular distal arch aneurysm. According to the patient's present symptoms, CT findings, and medical history, infected thoracic aneurysm was suspected. Total arch replacement was performed promptly, followed by thorough antibiotic therapy. Following successful treatment, the patient's condition stabilized, and she was transferred to a rehabilitation facility for further recovery.
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Affiliation(s)
- Hideki Sasaki
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Yukihide Numata
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Shinji Kamiya
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Yoshiaki Sone
- Cardiovascular Surgery, Nagoya City University East Medical Center, Nagoya, JPN
| | - Osamu Sasaki
- Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, JPN
- Internal Medicine, Kouiki Mombetsu Hospital, Mombetsu, JPN
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3
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Hanger M, Baker DM. Infective Native Extracranial Carotid Artery Aneurysms: A Systematic Review. Ann Vasc Surg 2023; 91:275-286. [PMID: 36549478 DOI: 10.1016/j.avsg.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes. METHODS We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021. RESULTS This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included hemorrhage, respiratory distress, and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In 5 cases, there was antibiotic treatment alone. In the open surgery-treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. CONCLUSIONS Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
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Affiliation(s)
- Melissa Hanger
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Daryll M Baker
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
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4
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Muacevic A, Adler JR. Mycotic Thoracic Aortic Aneurysm: Epidemiology, Pathophysiology, Diagnosis, and Management. Cureus 2022; 14:e31010. [PMID: 36349070 PMCID: PMC9632233 DOI: 10.7759/cureus.31010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/30/2022] Open
Abstract
Mycotic thoracic aortic aneurysm (MTAA) is an aneurysm of the aorta caused by infection of the vessel tissue through microbial inoculation of the diseased aortic endothelium. It is most commonly caused by bacteria. Rarely, it can be caused by fungi. However, viral aortic aneurysm has never been reported. Depending on the area and time period investigated, the infections organism discovered may vary significantly. Little is known about the natural history of MTAA due to its rarity. It is not known if they follow the same pattern as other TAAs. However, it is unclear whether MTAA follows a similar clinical course. The combination of clinical presentation, laboratory results, and radiographic results are used to make the diagnosis of MTAA. Treatment of MTAA is complex since patients frequently present at a late stage, frequently with fulminant sepsis, as well as concomitant complications such as aneurysm rupture. While medical treatment, including antibiotics, is recommended, surgery is still the mainstay of management. Surgery to treat MTAA is complicated and carries a high risk of morbidity and mortality and includes both open repairs and endovascular ones. In this review, we explore the etiology, pathogenesis, clinical presentations, diagnostic modalities as well as treatment management available for MTAA.
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5
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Bowers KM, Mudrakola V, Lloyd CM. Mycotic Aortic Aneurysm: A Rare Etiology of Septic Shock. Cureus 2022; 14:e24376. [PMID: 35611039 PMCID: PMC9124481 DOI: 10.7759/cureus.24376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 01/16/2023] Open
Abstract
Mycotic aneurysm of the aorta is a rare disease with a high mortality rate due to its likelihood of aneurysmal rupture. This syndrome is predominantly seen in patients over age 65 with the most common presenting symptoms being fever and back pain. Our case illustrates a mycotic aneurysm of the aorta presenting in an elderly female with vague abdominal pain, flank pain, and generalized weakness. We review the investigative approach, diagnostic modalities, and treatment options in patient management. This case emphasizes the need for a high index of suspicion of mycotic aneurysms of the aorta in critically ill elderly patients as early antibiotic therapy can be crucial for source control.
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Affiliation(s)
- Kaitlin M Bowers
- Emergency Medicine, Campbell University School of Osteopathic Medicine, Lillington, USA
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6
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Chen YY, Yang SF, Yeh HW, Yeh YT, Huang JY, Tsao SL, Yeh CB. Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population-Based Cohort Study. J Am Heart Assoc 2022; 11:e023267. [PMID: 35229623 PMCID: PMC9075302 DOI: 10.1161/jaha.121.023267] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Fluoroquinolones are first-line antibiotics recommended for the treatment of complicated urinary tract infections (UTIs), with frequent reports of adverse effects of aortic aneurysm (AA) and aortic dissection (AD). We examined whether fluoroquinolones can increase the risk of AA and AD in patients with UTIs in the Taiwanese population. Methods and Results We used the National Health Insurance Research Database to identify patients diagnosed with UTIs under single antibiotic treatment of fluoroquinolones and first-, second-, or third-generation cephalosporins. An AA and AD diagnosis within a year constituted the study event. Multivariable analysis with a multiple Cox regression model was applied for comparing the hazard risk of AA and AD between fluoroquinolones and first- or second-generation cephalosporins. Propensity score matching was performed to reduce the potential for bias caused by measured confounding variables. Among 1 249 944 selected patients with UTIs, 28 568 patients were assigned to each antibiotic group after propensity score matching. The incidence of AA and AD was not significantly different between the fluoroquinolones and first- or second-generation cephalosporins (adjusted HR [aHR], 0.86 [95% CI, 0.59-1.27]). However, the mortality increased in the fluoroquinolones group (aHR, 1.10 [95% CI, 1.04-1.16]). Conclusions Compared with first- or second-generation cephalosporins, fluoroquinolones were not associated with increased risk of AA and AD in patients with UTI. However, a significant risk of mortality was still found in patients treated with fluoroquinolones. The priority is to control infections with adequate antibiotics rather than exclude fluoroquinolones considering the risk of AA and AD for patients with UTI.
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Affiliation(s)
- Yin-Yang Chen
- Institute of MedicineChung Shan Medical University Taichung Taiwan.,Department of Surgery Chung Shan Medical University Hospital Taichung Taiwan
| | - Shun-Fa Yang
- Institute of MedicineChung Shan Medical University Taichung Taiwan.,Department of Medical Research Chung Shan Medical University Hospital Taichung Taiwan
| | - Han-Wei Yeh
- School of Medicine Chang Gung University Taoyuan City Taiwan.,Medical Education Department Chang Gung Memorial Hospital, Linkou Taoyuan City Taiwan
| | - Ying-Tung Yeh
- Graduate School of Dentistry School of Dentistry Chung Shan Medical University Taichung Taiwan.,Department of Dentistry Chung Shan Medical University Hospital Taichung Taiwan
| | - Jing-Yang Huang
- Institute of MedicineChung Shan Medical University Taichung Taiwan.,School of Medicine Chang Gung University Taoyuan City Taiwan
| | - Shao-Lun Tsao
- Department of Biomedical Engineering Chung Yuan Christian University Taoyuan Taiwan.,Department of Anesthesiology Changhua Christian Hospital Changhua Taiwan
| | - Chao-Bin Yeh
- Institute of MedicineChung Shan Medical University Taichung Taiwan.,Department of Emergency Medicine School of Medicine Chung Shan Medical University Taichung Taiwan.,Department of Emergency Medicine Chung Shan Medical University Hospital Taichung Taiwan
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7
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Ballaith A, Raffort J, Rajhi K, Salucki B, Drai C, Jean-Baptiste E, Hassen-Khodja R, Lareyre F. Mycotic aortic and left iliac ruptured aneurysm due to Escherichia Coli: a case report and literature overview. Acta Chir Belg 2022; 122:56-62. [PMID: 32253984 DOI: 10.1080/00015458.2020.1753146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Mycotic aneurysm is a life-threatening disease often caused by Salmonella, Staphylococci and Streptococci species. Interestingly, Escherichia Coli (E. Coli) is described as a rare causative agent. We report the case of a patient who developed a mycotic aortic and ruptured left iliac aneurysm due to E. Coli. The patient developed a secondary aortic graft infection due to a mesenteric ischemia with fecal peritonitis. A literature overview of the current knowledge on mycotic aortic aneurysms specifically due to E. Coli is discussed including the clinical characteristics of patients, the management of the disease and the post-operative outcomes.
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Affiliation(s)
- Ali Ballaith
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | - Juliette Raffort
- Department of Visceral Surgery, Université Côte d’Azur, CHU, Nice, France
- Clinical Chemistry Laboratory, University Hospital of Nice, Nice, France
| | - Khalid Rajhi
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | - Benjamin Salucki
- Department of Visceral Surgery, University Hospital of Nice, Nice, France
| | - Céline Drai
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
| | - Elixène Jean-Baptiste
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Department of Visceral Surgery, Université Côte d’Azur, CHU, Nice, France
| | - Réda Hassen-Khodja
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Department of Visceral Surgery, Université Côte d’Azur, CHU, Nice, France
| | - Fabien Lareyre
- Department of Vascular Surgery, University Hospital of Nice, Nice, France
- Department of Visceral Surgery, Université Côte d’Azur, CHU, Nice, France
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8
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Fuente R, Medina FJ, Moradillo N, Agúndez I, Herrero M, Santaolalla V. Persistent mycotic superficial femoral artery pseudoaneurysm after endovascular treatment: a case report. J Vasc Bras 2021; 20:e20200095. [PMID: 34630537 PMCID: PMC8483017 DOI: 10.1590/1677-5449.200095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/13/2020] [Indexed: 11/21/2022] Open
Abstract
Mycotic pseudoaneurysms of the superficial femoral artery (SFA) are rare and are usually secondary to colonization of an atherosclerotic plaque during an episode of bacteremia. We describe the case of a 68 year-old diabetic male who presented to the Emergency Department with pyrexia and a painful expanding mass in the left thigh. He had a history of diarrhea and had been treated 16 days earlier for an SFA pseudoaneurysm that had been excluded with a covered stent with no adjunctive antibiotic therapy. Angio CT showed an abscess surrounding femoral vessels and stent thrombosis. Under general anesthesia, we performed extensive debridement, removal of the endovascular material, SFA ligation, and empirical antibiotic therapy. Blood and tissue cultures were positive for Escherichia coli. At the 3-months follow up visit, the patient reported he had no claudication. In selected patients, mycotic pseudoaneurysms can be treated by SFA ligation.
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Affiliation(s)
- Ruth Fuente
- Burgos University Hospital, Vascular Surgery Department, Burgos, Spain
| | | | - Natalia Moradillo
- Burgos University Hospital, Vascular Surgery Department, Burgos, Spain
| | - Ignacio Agúndez
- Burgos University Hospital, Vascular Surgery Department, Burgos, Spain
| | - Mónica Herrero
- Burgos University Hospital, Vascular Surgery Department, Burgos, Spain
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9
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Scaillet J, Tessely H, Cherifi S. Ulnar infected pseudoaneurysm in the course of extended-spectrum beta-lactamase Escherichia coli septicemia. IDCases 2021; 26:e01292. [PMID: 34631422 PMCID: PMC8489153 DOI: 10.1016/j.idcr.2021.e01292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022] Open
Abstract
We describe the first case of proximal ulnar pseudoaneurysm due to extended-spectrum beta-lactamase-producing Escherichia coli. We performed an open ligation of the ulnar artery and partial excision of the aneurysmal sac. This article discusses the etiology and surgical management of ulnar-infected pseudoaneurysms according to the literature data.
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Affiliation(s)
- Jessika Scaillet
- Department of Vascular Surgery, C.H.U de Charleroi, Lodelinsart, Belgium
| | - Héloïse Tessely
- Department of Vascular Surgery, C.H.U de Charleroi, Lodelinsart, Belgium
| | - Soraya Cherifi
- Internal Medicine and Infectious Diseases Department, C.H.U de Charleroi, Lodelinsart, Belgium
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10
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Zekhnini I, Halleux D, Durieux R, Defraigne JO, Radermecker M, Tchana-Sato V. Mycotic aneurysm of the ascending aorta due to Escherichia coli: a case report. Acta Cardiol 2021; 77:643-646. [PMID: 34486498 DOI: 10.1080/00015385.2021.1973774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ascending aorta mycotic aneurysm is a rare entity. It is a life-threatening condition because of the possibility of aortic dissection, or rupture. Escherichia coli is recognised as an uncommon cause of aortic mycotic aneurysm. An 81-year-old woman with a history of Escherichia coli pyelonephritis 4 months previously, was admitted to our centre for a mycotic aneurysm of the ascending aorta caused by Escherichia coli. She was successfully treated by urgent in situ replacement of the ascending aorta with a cryopreserved homograft, combined with antibiotics. Although infrequent, Escherichia coli mycotic aneurysm should be suspected in older patients with atherosclerosis and who developed septicaemia. Prompt treatment with a combination of appropriate antibiotics and surgery is required.
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Affiliation(s)
- Ines Zekhnini
- Department of Cardiovascular Surgery, CHU Liege, Liège, Belgium
| | - Danae Halleux
- Department of Cardiovascular Surgery, CHU Liege, Liège, Belgium
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11
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Spontaneous Superficial Femoral Artery Mycotic Aneurysm. Case Rep Surg 2021; 2021:6613914. [PMID: 33728089 PMCID: PMC7935576 DOI: 10.1155/2021/6613914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/05/2021] [Accepted: 02/13/2021] [Indexed: 11/25/2022] Open
Abstract
Peripheral artery mycotic aneurysms are rare occurrences. In this case, we review a 52-year-old lady with poorly controlled diabetes who developed a spontaneous left superficial artery mycotic aneurysm. She underwent excision and subsequent extra-anatomic bypass with a great saphenous vein graft. She had full functional recovery after a short period of rehabilitation.
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12
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Wong ZW, Ong K. Anaemia secondary to Escherichia coli mycotic aneurysm. BMJ Case Rep 2021; 14:14/1/e237997. [PMID: 33509871 PMCID: PMC7845687 DOI: 10.1136/bcr-2020-237997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Mycotic aneurysms can pose a diagnostic dilemma due to their variable presentations. We present a case of a 93-year-old man initially presenting with fevers, intermittent chest pain and normocytic anaemia refractory to repeated blood transfusions. He received intravenous ceftriaxone as Escherichia coli grew in his blood cultures. His chest X-ray showed a widened mediastinum. A subsequent CT of the chest discovered a mycotic aneurysm at the descending thoracic aorta. He had a good outcome and was thriving after 1 year post endovascular repair.
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Affiliation(s)
- Zhi Wan Wong
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Kevin Ong
- Department of General Medicine, Armadale Health Service, Mount Nasura, Western Australia, Australia
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13
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Abstract
Mycotic (infected) aneurysm involving the thoracic aorta is an exceedingly rare and life-threatening condition that is associated with high morbidity and mortality. We report an unusual source of Proteus mirabilis bacteraemia thought to be due to an infected aneurysm in the thoracic aortic arch in an elderly woman. Source of gram-negative bacteraemia is usually isolated to an intra-abdominal or a pelvic source. Proteus bacteraemia from an intrathoracic pathology is very uncommon, and in this case led to a delay in diagnosis. Although an infected aneurysm is a rare source of gram-negative bacteraemia, it must always be considered when common causes of bacteraemia have been ruled out especially in patients with vascular risk factors.
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Affiliation(s)
- Sureshkumar Nagiah
- Department of General Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Rassam Badbess
- Department of General Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
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14
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Snead CM, Crockett SC, Bailey PK. Non-infectious aortitis in an immunosuppressed renal transplant recipient with IgA nephropathy. BMJ Case Rep 2017; 2017:bcr-2017-221136. [PMID: 29054943 DOI: 10.1136/bcr-2017-221136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 54-year-old woman presented with atypical chest pain, fever and malaise. She was immunosuppressed with three agents following a living-donor kidney transplant 1 year previously. Her native kidney failure was secondary to biopsy-demonstrated crescentic IgA nephropathy, with systemic involvement. A CT pulmonary angiogram revealed an inflammatory cuff of soft tissue around the descending thoracic aorta suggesting aortitis. Inflammatory markers were elevated. Given her immunosuppression, the patient was screened extensively for infective causes and was empirically commenced on intravenous meropenem. After 72 hours of no clinical or serological response to antibiotic therapy, negative microbiological investigations and worsening inflammation on serial imaging, she was commenced on high-dose methylprednisolone for presumed inflammatory aortitis. Symptoms and inflammatory markers rapidly normalisedand the patient was discharged home on oral prednisolone. A clinical diagnosis of IgA-related aortitis was made. Imaging 3 months later showed complete resolution of the aortitis.
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15
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Hwang SY, Clarke JMF, Tang TY. An infected enlarging abdominal aortic aneurysm after acute cholecystitis. Int J Surg Case Rep 2014; 5:237-9. [PMID: 24705192 DOI: 10.1016/j.ijscr.2014.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/19/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION An abdominal aortic aneurysm (AAA) infection is rare and can be difficult to manage, with high morbidity and mortality. We present a patient who suffered an infected AAA after undergoing a laparoscopic cholecystectomy and discuss the surgical management options. PRESENTATION OF CASE A 69-year-old male presents with a rapidly enlarging AAA 4 weeks following laparoscopic cholecystectomy. He was managed with open debridement, washout and repair of the aneurysm, but suffered ongoing sequelae of Escherichia coli sepsis. DISCUSSION The options for surgical management of infected AAA include open, endovascular and combined approaches. Recent papers report successful use of endovascular repair of infected AAAs but this is an ongoing area of research. CONCLUSION Infection of an AAA is associated with high mortality and long-term morbidity and requires optimal treatment. Surgical options include open debridement and repair, endovascular aneurysm repair (EVAR) or a combined approach.
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Affiliation(s)
- Sang Y Hwang
- Department of Vascular Surgery, Prince of Wales Hospital, Randwick, NSW, Australia; Prince of Wales Hospital Clinical School, University of New South Wales, Australia.
| | - James M F Clarke
- Department of Vascular Surgery, Norfolk and Norwich University Hospital, UK
| | - Tjun Y Tang
- Department of Vascular Surgery, Prince of Wales Hospital, Randwick, NSW, Australia; Department of Vascular Surgery, Norfolk and Norwich University Hospital, UK
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16
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Weyrich P, Ettahar N, Legout L, Meybeck A, Leroy O, Senneville E. First initial community-acquired meningitis due to extended-spectrum beta-lactamase producing Escherichia coli complicated with multiple aortic mycotic aneurysms. Ann Clin Microbiol Antimicrob 2012; 11:4. [PMID: 22321435 PMCID: PMC3297508 DOI: 10.1186/1476-0711-11-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 02/09/2012] [Indexed: 11/20/2022] Open
Abstract
We report the first case of extended-spectrum beta-lactamase producing E. coli community-acquired meningitis complicated with multiple aortic mycotic aneurysms. Because of the acute aneurysm expansion with possible impending rupture on 2 abdominal CT scan, the patient underwent prompt vascular surgery and broad spectrum antibiotic therapy but he died of a hemorrhagic shock. Extended-spectrum beta-lactamase producing E. coli was identified from both blood and cerebrospinal fluid culture before vascular treatment. The present case report does not however change the guidelines of Gram negative bacteria meningitis in adults.
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Affiliation(s)
- Pierre Weyrich
- Infectious diseases department, Dron hospital, Tourcoing, France
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18
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Tsai TC, Barot N, Dalman R, Mihm F. Combined endovascular and open operative approach for mycotic carotid aneurysm. J Vasc Surg 2010; 51:1514-6. [DOI: 10.1016/j.jvs.2009.12.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 12/10/2009] [Accepted: 12/23/2009] [Indexed: 12/18/2022]
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