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Atassi ASS, Vilanilam GK, Purushothaman R, Zemianschi R, Pandey I, Messer KJ, Vattoth S. Lumbar vertebral diskitis-osteomyelitis with mycotic abdominal aortic aneurysm caused by Streptococcus mitis. Radiol Case Rep 2024; 19:2719-2723. [PMID: 38680736 PMCID: PMC11046692 DOI: 10.1016/j.radcr.2024.02.039] [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: 12/08/2023] [Accepted: 02/12/2024] [Indexed: 05/01/2024] Open
Abstract
Vertebral osteomyelitis is a well-documented disease entity in literature with various known etiologies. However, vertebral diskitis-osteomyelitis secondary to an infected aortic aneurysm is an uncommon and life-threatening complication. We present the case of a 65-year-old male patient who presented with chronic low back pain that acutely worsened for 1 to 1.5 months and was diagnosed with vertebral diskitis-osteomyelitis secondary to a contiguous infection from an adjacent mycotic aortic aneurysm. To our knowledge, this is one of the few cases reported of vertebral diskitis-osteomyelitis secondary to mycotic aortic aneurysm. We discuss the findings on CT and MRI, as well as the value of imaging in guiding management.
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Affiliation(s)
| | - George K. Vilanilam
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Rangarajan Purushothaman
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Razvan Zemianschi
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Ishan Pandey
- Baylor Hankamer School of Business, Baylor University, Waco, TX 76706, USA
| | - Kurt J. Messer
- Division of Body Imaging, Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Surjith Vattoth
- Diagnostic Radiology & Nuclear Medicine, Division of Neuroradiology, Rush University Medical Center, Chicago, IL 60612, USA
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Cotugno S, Guido G, Manco Cesari G, Ictho J, Lochoro P, Amone J, Segala FV, De Vita E, Lattanzio R, Okori S, De Iaco G, Girma A, Sura A, Hessebo ET, Balsemin F, Putoto G, Ronga L, Manenti F, Facci E, Saracino A, Di Gennaro F. Cardiac Tuberculosis: A Case Series from Ethiopia, Italy, and Uganda and a Literature Review. Am J Trop Med Hyg 2024; 110:795-804. [PMID: 38412542 PMCID: PMC10993843 DOI: 10.4269/ajtmh.23-0505] [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: 08/01/2023] [Accepted: 11/19/2023] [Indexed: 02/29/2024] Open
Abstract
Extrapulmonary tuberculosis (TB) is estimated to account for up to 20% of active cases of TB disease, but its prevalence is difficult to ascertain because of the difficulty of diagnosis. Involvement of the heart is uncommon, with constrictive pericarditis being the most common cardiac manifestation. Diagnostic research for cardiac disease is frequently lacking, resulting in a high mortality rate. In addition to direct cardiac involvement, instances of cardiac events during antitubercular therapy are described. This case series describes five cases of TB affecting the heart (cardiac TB) from Italy and high-burden, low-income countries (Ethiopia and Uganda), including a case of Loeffler syndrome manifesting as myocarditis in a patient receiving antitubercular therapy. Our study emphasizes how cardiac TB, rare but important in high-burden areas, is a leading cause of pericardial effusion or pericarditis. Timely diagnosis and a comprehensive approach, including imaging and microbiological tools, are crucial. Implementing high-sensitivity methods and investigating alternative samples, such as detection of tuberculosis lipoarabinomannan or use of the GeneXpert assay with stool, is recommended in TB control programs.
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Affiliation(s)
- Sergio Cotugno
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Giacomo Guido
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Giorgia Manco Cesari
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | | | | | - James Amone
- St. John’s XXIII Hospital Aber, Jaber, Uganda
| | - Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Elda De Vita
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Rossana Lattanzio
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | | | - Giuseppina De Iaco
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Adisu Girma
- Doctors with Africa CUAMM, Wolisso, Ethiopia
| | - Abata Sura
- Doctors with Africa CUAMM, Wolisso, Ethiopia
| | | | | | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padua, Italy
| | - Luigi Ronga
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | | | - Enzo Facci
- Doctors with Africa CUAMM, Wolisso, Ethiopia
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, University of Bari, Bari, Italy
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Setake M, Uechi Y, Kinjo Y, Miyazato M, Nakachi N, Tomiyama R, Higa N, Hokama A. Rapid formation of aortoesophageal fistula complicated by mycotic thoracic aortic aneurysm secondary to infective endocarditis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38525841 DOI: 10.17235/reed.2024.10397/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
A 73-year-old man was admitted with four weeks of intermittent fever. He had a history of total aortic arch replacement for aortic arch aneurysm four years prior. CT scans showed no abnormalities before admission. Repeated blood cultures yielded Streptococcus anginosus and Prevotella melaninogenica, suggesting infective endocarditis (IE). Transesophageal echocardiography revealed a vegetation on the aortic valve, confirming IE. He suddenly presented with massive hematemesis and hypotension. Endoscopy revealed an elevated lesion with a laceration but no active bleeding in the esophagus. CT scans showed a thoracic aneurysm involving the esophagus. A diagnosis of aortoesophageal fistula (AEF) complicated by mycotic thoracic aortic aneurysm (MTAA) was made, and he underwent stent graft interpolation followed by minimally invasive esophagectomy. MTAAs are more prone to rupture than arteriosclerotic aneurysms as they are usually not true but pseudoaneurysms. Antecedent infection, including endocarditis, sepsis, predisposes to MTAA. AEF is a rare but life-threatening cause of gastrointestinal bleeding characterized by Chiari's triad. There have been no reports of such rapid formation of AEF after the graft replacement, as shown here. A recent article reported a rapid formation (16 days) of AEF after thoracic endovascular aortic repair, emphasizing prosthetic infection as the most important risk factor. Our case underscores the importance of suspecting AEF and conducting repeated appropriate examinations even if initial examinations do not reveal any aneurysms.
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Affiliation(s)
| | | | | | | | | | | | - Namio Higa
- Cardiovascular Medicine, Naha City Hospital
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Elshweikh SA, Abdellatif Ibrahim A, Saleh Almutairi W, AlHarbi F, Alrasheedi AA, Negm Eldine Said Mubark A, Ibrahim Basha E, Elkolaly RM. Mycotic Aortic Aneurysm Secondary to Salmonella enterica Infection: A Case Report and Treatment Approach. Cureus 2024; 16:e56399. [PMID: 38638711 PMCID: PMC11024485 DOI: 10.7759/cureus.56399] [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: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Mycotic (infected) aortic aneurysm is a severe clinical condition with high morbidity and mortality. Salmonella spp. is a Gram-negative, rod-shaped bacteria that is typically limited to the gastrointestinal tract and resolves spontaneously but can progress to invasive infections such as bacteremia. Serious complications may arise, particularly in debilitated, elderly, and neonatal patients. We describe the case of a 74-year-old female with a history of diabetes and hypertension who presented with shortness of breath, fever, chills, abdominal pain, vomiting, and diarrhea. The patient's blood culture tested positive for Salmonella enterica, and she was given ceftriaxone based on the results, but he remained symptomatic. A computed tomography scan of the chest with contrast revealed a mycotic aneurysm of the thoracic aorta. The patient was urgently transferred to a higher level of care and underwent emergency thoracic endovascular aortic repair with stenting and intravenous antibiotics. The presence of an infected aneurysm and associated abscess formation in such high-risk patients makes the endovascular approach more suitable than other options such as open surgery, aneurysmal excision and ligation without arterial reconstruction, excision with immediate reconstruction, and excision with interval reconstruction.
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Affiliation(s)
| | | | | | | | | | | | | | - Reham M Elkolaly
- Chest Diseases, Faculty of Medicine, Tanta University, Tanta, EGY
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Ikeda S, Nishimoto Y, Toma M, Sato Y. Rupture of Non-aneurysmal Mycotic Thoracic Aortic Arteritis Caused by Campylobacter fetus. Cureus 2023; 15:e50244. [PMID: 38192951 PMCID: PMC10774019 DOI: 10.7759/cureus.50244] [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: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
Campylobacter fetus (C. fetus) demonstrates a preference for vascular tissue and is an infrequent etiology of mycotic aortic arteritis (MAA), mostly occurring in the abdominal aorta. MAA characteristically has a rapid progression to aneurysm formation and subsequently, to aortic rupture. We present a 73-year-old woman with non-aneurysmal mycotic thoracic aortic arteritis (MTAA) complicated with a rupture caused by C. fetus. She presented after four days of pain in the lower abdomen. Contrast-enhanced computed tomography revealed non-aneurysmal descending thoracic aorta arteritis and an abdominal aorta aneurysm, and the blood cultures were positive for C. fetus. Antibiotic therapy relieved the abdominal pain. However, eight days after the antibiotic therapy, she died because of a rupture of the non-aneurysmal MTAA. The non-aneurysmal MTAA caused by C. fetus ruptured while the infection was being treated with appropriate antibiotics, and there was no sign of arterial dilatation. An early open or endovascular repair after a short pre-operative antibiotic therapy may be required for non-aneurysmal MAA caused by C. fetus. More cases of non-aneurysmal MAA caused by C. fetus are needed to determine the clinical course and to decide the treatment strategy.
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Affiliation(s)
- Shinya Ikeda
- Department of Pharmacology, Shiga University of Medical Science, Otsu, JPN
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
| | - Yuji Nishimoto
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
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Tadayon N, Shahsavari S, Mahya R, Nourmohammadi D, Jadidian F, Babaei M, Mousavizade M, Vakili K. A rare case of mycotic aortic aneurysm with Clostridium perfringens culture. Clin Case Rep 2023; 11:e8288. [PMID: 38107077 PMCID: PMC10724079 DOI: 10.1002/ccr3.8288] [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: 10/13/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
Key Clinical Message As only early diagnosis, prompt surgical intervention, and appropriate antibiotic therapy can decrease clostridial MAA mortality rate; keeping in mind a broad differential diagnosis in a patient with sepsis and unusual vascular symptoms is important. Abstract Mycotic aortic aneurysm (MAA) is an infrequent but very consequential condition characterized by the pathological disruption of the aorta due to infection. Clostridium perfringens is a bacterium that falls under the taxonomic classification of the genus Clostridium. Although mycotic aneurysm is often not commonly linked with this infection, there are instances when it may function as a causative agent for MAA. Timely diagnosis and thorough therapeutic techniques, including surgical intervention and quick administration of appropriate antibiotics, can potentially reduce the mortality rate associated with clostridial MAA. In this study, we presented a clinical report detailing the diagnosis of a mycotic aneurysm caused by C. perfringens in the thoracic aorta in a 66-year-old male patient with a history of diabetes mellitus and a recent prostate biopsy. Furthermore, we discussed the surgical approach and overall management strategy to address this case.
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Affiliation(s)
- Niki Tadayon
- Shohada Tajrish HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Saleh Shahsavari
- Department of SurgeryShohada Tajrish Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | - Reyhane Mahya
- Student Research CommitteeSchool of Medicine, Shahid Beheshti University of Medical SciencesTehranIran
| | - Delaram Nourmohammadi
- Student Research CommitteeSchool of Medicine, Shahid Beheshti University of Medical SciencesTehranIran
| | - Faezeh Jadidian
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Masoud Babaei
- Department of SurgeryShohada Tajrish Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | - Mostafa Mousavizade
- Heart Valve Disease Research CenterRajaie Cardiovascular Medical and Research Center, Iran University of Medical SciencesTehranIran
| | - Kimia Vakili
- Student Research CommitteeSchool of Medicine, Shahid Beheshti University of Medical SciencesTehranIran
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Dadana S, Ingnam S, Kondapalli A. A Rare Case of Mycotic Aneurysm Due to Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia. Cureus 2023; 15:e40336. [PMID: 37456379 PMCID: PMC10338717 DOI: 10.7759/cureus.40336] [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: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Mycotic aneurysm is defined as an infection of the arterial wall either by fungi or bacteria. Although, a rare complication of infection, it is associated with high morbidity and mortality. We describe a 69-year-old female with a rare thoracic aortic mycotic aneurysm, with no clear source of infection and a predominantly atypical presentation, manifesting primarily as heart failure, at a rural community hospital. Our case also depicts the rapid development of aortitis and mycotic aneurysms. This case highlights the challenges in the diagnosis and management of this condition.
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Affiliation(s)
- Sriharsha Dadana
- Internal Medicine, Cheyenne Regional Medical Center, Cheyenne, USA
| | - Sisham Ingnam
- Internal Medicine and Infectious Disease, Cheyenne Regional Medical Center, Cheyenne, USA
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