Multiple liver abscesses secondary to Listeria monocytogenes complicated by hepatic artery mycotic aneurysm

A woman in her 50s presented to the emergency department with 5 days of abdominal pain, nausea and vomiting. CT imaging of her liver demonstrated three enhancing, cystic lesions in her hepatic parenchyma and a large enhancing lesion in her porta hepatis concerning for a hepatic artery aneurysm. Radiographic-guided drainage was performed on two accessible liver abscesses, and cultures from this drainage grew Listeria monocytogenes Serial imaging of the aneurysm demonstrated that the aneurysm spontaneously thrombosed and did not require further intervention. She was subsequently discharged on intravenous ampicillin with a plan to continue until radiographic resolution of the abscesses.

Life threatening, subclavian artery mycotic aneurysm rupture into a gigantic supraclavicular abscess in an intravenous drug user

Subclavian artery injuries are sporadic, and the most common aetiology is trauma. Self-injury of the vessel in those misusing intravenous drugs is a rare complication, as most reports describe injury to the femoral artery. Thus, erosion and potential rupture of the arterial wall is possible due infection and phlegmon or abscess formation. We present a case of a young, female, hemodynamically unstable intravenous drug user admitted to the emergency department with a life-threatening, purulent haemorrhagic mass located at her right lateral cervical region. The patient admitted an inadvertent arterial puncture 10 days prior and an effort to self-manage the bleeding with the application of self-pressure and antibiotics. Computed tomography arteriogram of the neck revealed a gigantic, multicompartment, thick-walled collection with hyperdense fluid in her right supraclavicular region while active extravasation derived from the right subclavian artery was evident in late arterial phase. The patient was treated with endovascular graft stenting, despite the given presence of infection, as a salvage operation due to time limitation in open surgical repair.

Case of Mycotic Coronary Aneurysm Treated with Percutaneous Coil Embolization

Mycotic coronary aneurysms are rare, with potentially fatal complications. The treatment of choice is surgical intervention. We present a case of a mycotic coronary aneurysm secondary to a catheter-related bloodstream infection, failed surgical treatment, and eventual treatment with percutaneous coil embolization.

The Association of Spondylitis and Aortic Aneurysm Disease

OBJECTIVES

The aim of this study is to assess any relation between spondylitis and aortic aneurysmal disease by reviewing the current literature.

METHODS

A systematic search was undertaken using MEDLINE, EMBASE and CENTRAL databases till May 2019, for articles reporting on patients suffering from spondylitis and aortic aneurysm.

RESULTS

The most involved aortic segment was infrarenal aorta (56.9%). The lumbar vertebrae were more frequently affected (79.7%). Commonest symptoms were back pain (79.1%), fever (33.7%) and lower limb pain (29.1%). 55.8% of cases were diagnosed using computed tomography. The pathology was attributed to infectious causes in 25.1% of cases. 53.4% of patients were treated only for the aneurysm, 27.9% for both pathologies, while two patients solely for the vertebral disease. Endovascular aneurysm repair was chosen in 12.8% of cases. The 30-day mortality was 8.1% (7/86); mostly from vascular complications.

CONCLUSIONS

A synchronous spondylitis and aortic aneurysm may share common etiopathology, when an infectious or inflammatory cause is presented. The lumbar vertebrae are more frequently affected. Low quality data do not allow safe conclusion to suggest the best treatment option.

Mycotic Aneurysm of Brachial Artery in Case of Aplastic Anemia

Pseudo-aneurysm of the brachial artery is relatively rare condition affecting the arterial vessels of the limbs. It can be due to trauma, infections or systemic vasculitis. We report a patient with aplastic anemia who developed pseudoaneurysm of the brachial artery following an episode of bacterial sepsis. Methicillin resistant Staphylococcus aureus (MRSA) was isolated on blood culture. Patient was treated with systemic antibiotics and underwent embolization of the pseudo-aneurysm. He later developed vascular insufficiency of the forearm and a stent had to be placed in the brachial artery at the site of calcified thrombus inside the pseudo-aneurysm to produce the patency of the artery and ensure adequate blood flow to forearm and hand.

[Infected Thoracic Aortic Aneurysm Secondary to the Purulent Pericarditis;Report of a Case]

A 69-year-old man was hospitalized urgently to the department of cardiology, with the progressive general malaise. On admission, his blood pressure was 80/42 mmHg, his white cell count 13,700/µl, and C-reactive protein 25.55 mg/dl suggesting existence of aggressive infection with impaired circulation. Massive pericardial effusion was detected in echocardiography. Pericardial drainage was undergone promptly. There was drainage of 700 ml and the property was purulent. Pneumococcus was detected by the culture test of the pericardial fluid. Antibiotic administration was started by a diagnosis of the purulent pericarditis. His general condition was improved. However, a rapidly expanding saccular aneurysm was found in a descending thoracic aorta by computed tomography( CT). As an infected thoracic aortic aneurysm secondary to the purulent pericarditis, we performed thoracic endovascular aneurysm repair (TEVAR). The intravenous administration of antibiotics was continued for 2 weeks after TEVAR, which was followed by oral antibiotic administration for 1 year. The aneurysm completely disappeared by CT, 10 months after TEVAR. In case with an infected thoracic aortic aneurysm, TEVAR can be a 1st choice of treatment, depending on a causative organism and the morphology of the aneurysm.

[Tuberculous mycotic aneurism of the aorta: a case report of haemoptysis.]

Mycotic aneurysm secondary to tuberculous infection (TB) of the aorta is a rare and life-threatening disease. We report a case report of a 78-year-old woman with a tuberculous mycotic aortic aneurysm (TBAA). Early diagnosis and a combination of surgical intervention (aortic reconstruction and extensive excision of the infected field) and prolonged antituberculous drug therapy provide long-term survival without evidence of recurrence after tuberculous aortic involvement.

[Mycotic aneurysms: a case report, clinical review, imaging appearances and management]

To report a clinical case of mycotic thoracic aortic aneurysm. To describe and illustrate the spectrum of MDCT findings, analysing the pathophysiology, diagnostic evaluation and therapeutic management. To emphasis the early non-invasive diagnosis as a way to overall survival improvement. A mycotic aneurysm is an uncommon vascular lesion resulting from arterial wall destruction by infection, generally involving the peripheral arteries or aorta and rarely the cerebral and visceral arteries. Defined as a lobulated saccular outpouching of the wall communicating with the lumen, it is surrounded by oedema, hematoma and/or fibro-inflammatory tissue. Due the non-specific and delayed - or even absent - manifestations, a high degree of clinical suspicion is necessary to achieve a timely treatment and prognosis improvement. In this setting, radiologic evaluation - mainly by MDCT angiography - is essential, allowing detection, characterization and complications assessment before treatment planning.

Healthy Adolescent with a Mycotic Aortic Aneurysm from Community-Acquired Methicillin-Resistant Staphylococcus aureus

Mycotic aneurysm after bacteremia is a rare diagnosis in children and adolescents. We report the case of a previously healthy adolescent who presented with chest pain and fever and who developed a mycotic aneurysm of the aorta after contracting community-acquired, methicillin-resistant Staphylococcus aureus. Early recognition of widening of the patient's superior mediastinum, noted during a comparison of the patient's initial and follow-up chest radiographs, prompted computed tomographic angiography of the chest and led to a timely diagnosis, rapid surgical intervention, and a good clinical outcome. To our knowledge, this is the first reported case of mycotic aortic aneurysm from community-acquired methicillin-resistant S. aureus in a healthy adolescent who had no predisposing cardiac or aortic anomalies.

Giant Ruptured Common Iliac Artery Infected Aneurysm

INTRODUCTION

Saccular mycotic aorto-iliac aneurysms are extremely rare and when presented with ruptured, they are an important life- threatening condition.

METHODS

We present a 52 years old male transferred from another Hospital and admitted to the emergency room with a ruptured iliac artery aneurysm.

RESULTS

He complained of persistent fever and abdominal discomfort that swiftly established as hemorrhagic shock. Imagiological study with angioCT revealed a ruptured left common iliac artery saccular aneurysm with 90mm. The patient was instantaneously and successfully submitted to endoaneurismorraphy, common and external iliac artery ligation and construction of an extra anatomic bypass, right to left femoro-femoral bypass. Blood culture revealed a Streptococcus anginosus and the patient received appropriate targeted antibiotics. Post-operative period was uneventful and the patient discharged ten days after admission. He has now eleven months of follow up with no intercurrences.

CONCLUSION

Long term antibiotics along with aggressive surgical debridement of the infected tissue and vascular revascularization with an extra anatomic bypass remain the most definitive solution while endovascular aneurysm repair may generally constitute a bridge life-saving procedure in mycotic infected aneurysms. Even though surgical approach carries a relative risk of perioperative morbidity it is a feasible and durable solution for extreme situations like the one here described.

Red blood cell transfusion-transmitted acute hepatitis E in an immunocompetent subject in Europe: a case report

BACKGROUND

Acute hepatitis E in industrialized countries is usually related to intake or manipulation of undercooked or raw meat. Cases of transfusion-transmitted hepatitis E have rarely been documented in immunosuppressed patients, mainly after receiving frozen plasma.

STUDY DESIGN AND METHODS

A 61-year-old man was admitted to hospital for jaundice. His personal history included disseminated bacillus Calmette-Guerin infection treated with antituberculous drugs. He had received red blood cell (RBC) transfusion 2 months previously, during admission for mycotic aneurysm surgery. Since liver function tests worsened despite stopping antituberculous drugs, other causes of acute hepatitis were explored.

RESULTS

Acute hepatitis E was diagnosed by the presence of both immunoglobulin M and hepatitis E virus (HEV) RNA. Traceback procedure for the 8 RBC units was carried out, and one of the eight archive plasma samples tested positive for HEV RNA, with an estimated viral load of 75,000 IU/mL. Phylogenetic analysis revealed the same HEV strain Genotype 3 in one of the transfused RBC products and in the patient's serum sample.

CONCLUSION

Transfusion of RBCs with detectable HEV RNA is a risk factor for acute hepatitis E in immunocompetent patients in Europe.

Endovascular therapy for visceral artery aneurysms

BACKGROUND

The aim of this study was to report outcome and complications of endovascular therapy for visceral artery aneurysms (VAA).

METHODS

Forty endovascular procedures for VAAs were performed in 33 patients between 2009 and 2014.

RESULTS

The main indications was size (N.=15), bleeding (N.=14) and mycotic aneurysm (N.=3). The splenic artery was the most common artery of true aneurysms (11/16) and pseudo aneurysms due to pancreatitis (5/14). The median size of the true aneurysms was 24 mm (range 15-65). Two ruptures of true VAAs occurred in elderly. Five patients had eleven synchronous artery aneurysms at CT abdomen. Local anesthesia was used in 93%. Coil embolization were performed without (N.=15) and with (N.=14) other techniques. Nine aneurysms were excluded with stent grafts and patency rate was 88%. Coil embolization was complicated by five spleen infarctions, managed with splenectomy (N.=1) and drainage of abscess (N.=1). One patient died, unrelated to the VAA.

CONCLUSIONS

Endovascular therapy of VAAs, irrespective of etiology, was an effective treatment option.

Left Anterior Descending Coronary Artery and Multiple Peripheral Mycotic Aneurysms Due to Mycobacterium Bovis Following Intravesical Bacillus Calmette-Guerin Therapy: A Case Report

The use of live attenuated intravesicular Bacillus Calmette-Guerin (BCG) therapy is a generally accepted safe and effective method for the treatment of superficial transitional cell carcinoma (TCC) of the bladder. Although rare, < 5% of patient's treated with intravesicular BCG therapy may develop potentially serious complications, including localized infections to the genitourinary tract, mycotic aneurysms and osteomyelitis. We present here a case of a 63-year-old male who developed left coronary and multiple peripheral M. Bovis mycotic aneurysms as a late complication of intravesicular BCG therapy for superficial bladder cancer. The patient initially presented with acute onset pain and swelling in the left knee > 2 years following initial therapy, and initial workup revealed a ruptured saccular aneurysm of the left popliteal artery as well as incidental bilateral common femoral artery aneurysms. Following endovascular treatment and additional workup, the patient was discovered to have additional aneurysms in the right popliteal artery and left anterior descending artery (LAD). Surgical pathology and bacterial cultures obtained from the excised femoral aneurysms and surgical groin wounds were positive for Mycobacterium Bovis, and the patient was initiated on a nine-month antimycobacterial course of isoniazid, rifampin and ethambutol. Including the present case, there has been a total of 32 reported cases of mycotic aneurysms as a complication from intravesicular BCG therapy, which we will review here. The majority of reported cases involve the abdominal aorta; however, this represents the first known reported case of a coronary aneurysm.

Salmonella Aortic Aneurysm: Suggestions for Diagnosis and Therapy Based on Personal Experience

Infectious aneurysm is a rare event, especially after the introduction of antibiotic therapy. However, its early detection is very important for timely treatment with antibiotics and surgical intervention. This pathology may generally be due to mycotic endocarditis or septic embolization, prevailing in the preantibiotic era, and to aortitis, whose incidence is actually increasing, mainly in subjects with preexisting large-vessel atherosclerosis and intimal defects. This clinical entity is usually defined as microbial arteritis and recognizes Salmonella spp as the microorganism most frequently isolated from blood or vascular tissue cultures. The authors present the case of a 56-year-old man with a history of hypertension that some weeks before admission manifested as hyperpyrexia and episodic lumbar pain, associated with hepatosplenomegaly and with a pulsing mass in the periumbilical region. Abdominal computed tomography (CT) scan documented a voluminous infrarenal aortic aneurysm with a markedly reduced and irregular vessel wall. The patient underwent surgical excision of the aneurysm, during which marked periaortic inflammation phenomena, complete absence of the posterior aortic wall for a length of 5-6 cm, and the exposure of the correspondent vertebral bodies were observed. Histopathologic examination of the aneurysmal tissue showed atheromatous and thrombotic aspects and confirmed strong signs of inflammation. This case may suggest that the occurrence of microbial aortitis, especially from Salmonella spp, should be taken into account in the presence of a septic status associated with back, abdominal, or thoracic pain.

Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm

Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature.

Endovascular Treatment of Mycotic Hepatic Artery Aneurysm in the Hostile Abdomen

Mycotic hepatic artery aneurysms are rare. This report documents a case in which a mycotic hepatic artery aneurysm was associated with Crohn's disease, renal adenocarcinoma, and a urinary tract infection. Endovascular management of this mycotic hepatic artery aneurysm was successful in the setting of a hostile abdomen based on multiple previous operations, a stoma, and a scarred abdomen.

Mycotic Aneurysm and Aortic Graft Infection Presenting with Vertebral Body Destruction Requiring Debridement and Stabilization

Vertebral osteomyelitis may occur with mycotic aneurysms or infected aortic grafts. A high index of suspicion for these concurrent processes as well as appropriate preoperative evaluation and interspecialty communication is critical for appropriate diagnosis and treatment. Extraanatomic bypass, wide debridement of necrotic soft tissue and bony structures, and concurrent bony stabilization are important aspects of treatment.

[Stent graft for rapidly growing thoracic mycotic aneurysm in a patient with advanced lung cancer]

We report a compromised patient with mycotic aneurysm, who was successfully treated by urgent placement of a stent graft. A man in his seventies was admitted to our hospital with relapsing high fever and back pain during chemotherapy for advanced squamous cell carcinoma of the lung. Contrast CT demonstrated a saccular aneurysm of the thoracic aorta and left pleural effusion. Blood cultures were positive for Escherichia coli producing extended spectrum beta-lactamase (ESBL). Therefore, thoracic mycotic aneurysm was diagnosed. Because of rapid growth on consecutive examinations, absolute bed rest was required. Therefore, we performed antibiotic therapy combined with stent graft placement, which achieved complete exclusion of the aneurysm. He was discharged in an ambulatory state, and his quality of life remained good at home until just before death from terminal state of the cancer.

A rare but potentially lethal case of tuberculous aortic aneurysm presenting with repeated attacks of abdominal pain

Tuberculous aortic aneurysm is an extremely rare disease with a high mortality rate. The clinical features of this condition are highly variable, ranging from asymptomatic with or without constitutional symptoms, abdominal pain to frank rupture, bleeding and shock. We herein report the case of a 56-year-old man with a large tuberculous mycotic aneurysm in the abdominal aorta with an initial presentation of repeated attacks of abdominal pain lasting for several months. Due to the vague nature of the initial symptoms, tuberculous aortic aneurysms may take several months to diagnose. This case highlights the importance of having a high index of suspicion and providing timely surgery for this rare but potentially lethal disease.

Concurrent Salmonella mycotic abdominal aneurysm and empyema thoracis: a rare coincidence

OBJECTIVE

To present a case of Salmonella bacteremia with a rare metastatic focus.

CLINICAL PRESENTATION AND INTERVENTION

A 61-year-old male presented with a suicide attempt after ingestion of half a bottle of toilet cleaner. He had a medical history of intravenous drug abuse and major depression. Persistent Salmonella enteritidis bacteremia occurred during his hospitalization, and a search for the primary source of infection disclosed a mycotic abdominal aortic aneurysm. A suppurative lesion was also noted over the left pleural space, and Salmonella empyema was confirmed after thoracentesis. He underwent video-assisted thoracoscopic surgery and endovascular repair of the abdominal aortic aneurysm and was placed on long-term antibiotics, without recurrence.

CONCLUSION

S. enteritidis involvement of the cardiovascular system is a rare coincidence and results in significant morbidity and mortality. In addition, the phenomenon of secondary metastatic infective foci involving the pleural space has an even lower frequency than that of cardiovascular involvement. Therefore, a high index of suspicion and prompt treatment from the treating physicians are strongly recommended.

Symptomatic peripheral mycotic aneurysms due to infective endocarditis: a contemporary profile

Peripheral mycotic aneurysms (PMAs) are a relatively rare but serious complication of infective endocarditis (IE). We conducted the current study to describe and compare the current epidemiologic, microbiologic, clinical, diagnostic, therapeutic, and prognostic characteristics of patients with symptomatic PMAs (SPMAs). A descriptive, comparative, retrospective observational study was performed in 3 tertiary hospitals, which are reference centers for cardiac surgery. From 922 definite IE episodes collected from 1996 to 2011, 18 patients (1.9%) had SPMAs. Because all SPMAs developed in left-sided IE, we performed a comparative study between 719 episodes of left-sided IE without SPMAs and 18 episodes with SPMAs. We found a higher frequency of intravenous drug abuse, native valve IE, intracranial bleeding, septic emboli, multiple embolisms, and IE diagnostic delay >30 days in patients with SPMAs than in patients without SPMAs. The causal microorganisms were gram-positive cocci (n =10), gram-negative bacilli (n = 2), gram-positive bacilli (n = 3), Bartonella henselae (n = 1), Candida albicans (n = 1), and negative culture (n = 1). The median IE diagnosis delay was 15 days (interquartile range [IQR], 13-33 d) in the case of high-virulence microorganisms versus 45 days (IQR, 30-240 d) in the case of low- to medium-virulence microorganisms. Twelve SPMAs were intracranial and 6 were extracranial. In 10 cases (8 intracranial and 2 extracranial), SPMAs were the initial presentation of IE; the remaining cases developed symptoms during or after finishing parenteral antibiotic treatment. The initial diagnosis of intracranial SPMAs was made by computed tomography (CT) or magnetic resonance imaging in 6 unruptured aneurysms and by angiography in 6 ruptured aneurysms. The initial test in extracranial SPMAs was Doppler ultrasonography in limbs, CT in liver, and coronary angiography in heart. Four (3 intracranial, 1 extracranial) of 7 (6 intracranial, 1 extracranial) patients treated only with antibiotics died. Surgical resection was performed in 7 (3 intracranial, 4 extracranial) and endovascular repair in 4 (3 intracranial, 1 extracranial) patients; all of them survived. In conclusion, we found that SPMAs were a rare complication of IE that developed only in left-sided IE, and especially in native valves. Intracranial hemorrhage, embolism, multiple embolisms, and diagnostic delay of IE were more common in patients with SPMAs. The microbiologic profile was diverse, but microorganisms of low-medium virulence were predominant, and had a greater delayed diagnosis of IE than those caused by microorganisms of high virulence. SPMAs were often the initial presentation of IE. The most common location of SPMAs was intracranial. Noninvasive radiologic imaging techniques were the initial imaging test in intracranial unruptured SPMAs and in most extracranial SPMAs. Surgical and endovascular treatments were safe and effective. Endovascular treatment could be the first line of treatment in selected cases. Mortality was high in those cases treated only with antibiotics.

Salmonella mycotic thoracoabdominal aortic aneurysm associated with chronic lymphocytic leukemia

Non-typhoidal Salmonella infections typically cause self-limiting gastroenteritis. However, extraintestinal focal infections, including mycotic aneurysms of the aorta, can also occur. We present the case of a 71-year-old man with chronic lymphocytic leukemia (CLL) and a large type V thoracoabdominal mycotic aneurysm infected with Salmonella enteritidis, complicated by thoracolumbar spondylodiscitis, paravertebral collections, and epidural abscess. This is the first report of Salmonella aortitis in the setting of CLL, and the unusual extent of local infective invasion seen here with Salmonella enteritidis infection raises a suspicion of CLL-related immunosuppression as a direct predisposing factor. This case illustrates the need to consider the possibility of an immune defect, even in CLL patients with normal leukocyte counts. The underlying mechanisms are unclear, but are likely to involve defects in cell-mediated immunity, thought to be of particular importance in invasive infections with intracellular pathogens such as Salmonella spp.

Mycotic thoracic aortic aneurysm: review of the diagnostic and therapeutic options

Along with greater life-expectancy, the prevalence of aortic aneurysm and its infected complicated variant increases. We present the case of a mycotic aortic aneurysm. Mycotic aneurysms represent only between 0.7% and 2.6% of all aortic aneurysms. It is a highly lethal variant of the classical aortic aneurysm in which death supervenes in all cases that are left untreated. Up to 60% of mycotic aortic aneurysms may present as ruptured. Time from admission to diagnosis of mycotic thoracic aortic aneurysm ranges from 1 to 4 days and the time from diagnosis to the necessity of surgery 1 to 11 days. Adequate knowledge about the diagnostic and therapeutic options is mandatory improve survival and will be reviewed in this article.

Tuberculous iliac artery aneurysm in a pediatric patient

Vascular complications of tuberculous infections are rare and occur even less frequently in the pediatric population. Tuberculous pseudoaneurysms can occur either as a result of contiguous spread from a neighboring focus-invariably infected lymph nodes-or by hematogenous spread and seeding of acid-fast bacilli that lodge in the adventitia or media via the vasa vasorum. We report a case of turberculous right common iliac artery pseudoaneurysm in a 12-year-old and review the relevant literature.

Salmonella mycotic aneurysm: a rare cause of fever and back pain in elderly

An 85-year-old man with history of hypertension presented with fever, cough and abdominal pain. Unfortunately fever and leukocytosis persisted despite treatment. Blood cultures obtained on admission grew Salmonella enteritidis. Subsequently he developed increasing back pain and transoesophageal echocardiography (TOE) was performed, demonstrating a complex ulcer at the aortic arch with multiple small mobile strandlike densities suggestive of vegetation. Contrast thoracic CT scan confirmed an ulcerated atherosclerotic plaque which progressively increasing in size over 3 months despite antibiotics. Therefore, a stent was deployed in view of high risk of perforation and he was placed on prolonged antibiotics. Post-stenting CT scan a few months later showed a patent stent with the aneurysm remained stable in size. Cardiovascular infections develop in approximately 25 % of patients with Salmonella bacteremia. Most patients with Salmonella aortitis have preexisting atherosclerosis at the site of the subsequently infected aneurysm. The diagnosis of S. aortitis can be challenging, because the clinical course may be indolent and the symptoms are nonspecific. A high index of suspicion is required to make the diagnosis of S. aortitis, especially in patients with Salmonella bacteraemia, fever, back pain and/or abdominal pain. This case highlights the usefulness of TOE in the evaluation of diseases involving the thoracic aorta, leading to a successful intervention.

[Large infectious thoracoabdominal aortic aneurysm in a chronic contained rupture, treated successfully using the "simplified technique"]

The clinical case of a 72-years old male is reported, admitted into a Medical Department through the Emergency Service, with a clinical picture of heavy lumbar pain, with walking compromise and acute urinary retention, lasting for several hours. Laboratory analysis revealed a marked elevation of acute inflammatory parameters and a renal failure, expressed by 108 mg/dl of urea and 4.4 mg/dl of creatinine. The patient was admitted with the provisional diagnosis of acute prostatitis, pos-renal acute renal insufficiency and dorso-lumbar pathology of unknown etiology. Three consecutive and subsequent hemocultures allowed the isolation of a Streptococcus pneumonae strain and a CT dorso lumbar spine evaluation disclosed a D11 to D12 spondylodiscitis, with a partial destruction of the vertebral bodies and an extensive throracoabdominal aortic aneurysm adjacent to those vertebrae, with some characteristic features of an infectious aneurysm. Simultaneously, an hemothorax on the left chest was noticed, consequence of a chronic contained rupture of the aneurysm. Following an intensive and specific antibiotic therapy and with an almost completed recovery of the renal function, he underwent surgical management, consisting in the evacuation and drainage of the hemothorax, followed by resection of the aneurysm and extensive tissular debridmente, culminating in the vascular reconstruction utilizing the "simplified technique", introduced in 1984 by A. Dinis da Gama for the surgical management of thoracoabdominal aortic aneurysms. The patiente tolerated the procedure well, with no intercorrences or complications and the post operative course was unventfull. One month later, a CT-angio control disclosed the revascularization procedure working in excellent condition. Finally, an orthopedic artrodhesis of the injuried vertebrae was performed, allowing an easy and pain-free walking and he was discharged on day 60, under antibiotic treatment. The main features of this clinical case are emphasized and discussed, namely those aspects related to its pathogenesis, clinical presentation, diagnosis and surgical management.

Treatment of an acute mycotic aneurysm of the common carotid artery with a covered stent-graft

We report herein a case successful endovascular treatment with a stent-graft of a rare case of rapidly growing mycotic aneurysm of the left common carotid artery due to acute bacterial endocarditis after eradication of the infection. Infected mycotic aneurysms of the peripheral vasculature have been considered as a contraindication for stent-graft implantation because of the possibility of microorganism spreading to the stent-graft; however, if there is evidence of complete eradication of microorganism and surgery is not an option, stent-graft implantation can be an effective and safe treatment modality for exclusion of the mycotic aneurysm.

Mycotic aneurysm of the popliteal artery due to infective endocarditis

Mycotic aneurysm (MA) is an infrequent complication of infective endocarditis (IE), reported in 3 to 15% of the patients with IE. The commonest site for such aneurysm is intracranial vessels (65%) followed by abdominal and then the peripheral vessels. We describe a case of 32 year old man with recently diagnosed rheumatic heart disease and mitral regurgitation. He had infective endocarditis (IE) and developed a large mycotic popliteal artery aneurysm (MPAA) and a small profunda femoris arterial aneurysm (PFAA) while he was on antibiotic therapy. The patient was successfully treated with prolonged antibiotic therapy and embolisation of the MPAA while PFAA was managed conservatively.

Infectious intracranial aneurysms: triage and management

Infectious intracranial aneurysms are a rare but serious potential complication of subacute endocarditis. Early diagnosis and treatment is essential to prevent devastating neurological deficits and mortality. Because nurse practitioners' roles expand into acute care as well as urgent care settings, they are frequently involved in the care of this population. Identifying the patients at risk, ordering appropriate studies, and initiating goal directed therapy are vital to outcomes. For nurse practitioners who are involved in care of neuroscience populations, it is important to be familiar with disease processes. This article provides a literature review of the topic, explores diagnostic methods, discusses management strategies, and presents an illustrative case.

[Unusual cause of Staphylococcus aureus septicemia in a 79-year-old male patient]

High grade fever in the context of Staphylococcus aureus bacteremia led to hospital admission of a 79 year old male patient. A covered perforation of the ascending aorta resulted in the formation of a pseudoaneurysm which was complicated by superinfection caused by hematogenic spread of Staphylococcus aureus. The infected pseudoaneurysm found per continuitatem contact to the pericardium and resulted in bacterial pericarditis. Antibiotic pretreatment was followed by operation with a complex procedure including resection of pseudoaneurysm and suture closure of the perforation site.

An infected abdominal aortic aneurysm due to non-typhoidal Salmonella in an HIV-1-infected Japanese patient

We herein report a case study of an HIV-1-infected 64-year-old Japanese man who presented, with an abdominal aortic aneurysm due to non-typhoidal Salmonella. He was admitted with a 7-day history of intermittent left back pain. A culture of a blood specimen yielded gram-negative bacilli, which were identified as non-typhoidal Salmonella. Computed tomography showed an abdominal aortic aneurysm due to the non-typhoidal Salmonella infection. Since such a complication is frequently fatal, its management, especially the timing of surgery, is difficult. Further studies are needed to determine the optimal treatment strategy, however, early diagnosis and prompt careful treatment can reduce mortality.

Diagnosis and management of aortic mycotic aneurysms

We reviewed all papers most recently reported in the literature (January-December 2008) with regard to infected arterial aneurysms (IAAs) affecting the aorta. Most of the recently reported knowledge is limited to case reports and small series of aortic mycotic aneurysms. Most patients are elderly men and have comorbidities at presentation. Aneurysms were most commonly associated to Salmonella and Staphylococcus. However, several cases of aortic IAAs caused by atypical pathogens were also reported, likely due to an increase in immunosuppressive illnesses, increased life expectancy, improved diagnostic methods, and increasing medical awareness. Open surgical therapy of IAAs remains the gold standard. Some have reported successful outcomes with endovascular methodologies for patients medically compromised or for particular challenging clinical or anatomical scenarios. However, at this time, conclusive evidence is lacking and it should be in general considered a bridge to open repair. The latter should be planned at the earliest possible, when medically permissible.

Mycotic aneurysm caused by burkholderia pseudomallei with negative blood cultures

We describe a case of bacterial aortitis caused by Burkholderia pseudomallei. This patient presented with prolonged fever and hoarseness of voice. Aneurysm removal with Dacron graft replacement was performed, followed by a prolonged course of antibiotics. The patient has progressed satisfactorily without recurrence of symptoms. Previous case reports are summarized.

[Antibiotic-resistant infectious thoracoabdominal aortic aneurysm; report of a case]

A 76-year-old female presented with constipation and anorexia Computed tomography (CT) revealed a saccular aneurysm (35 mm in diameter) directly over the root of the celiac artery, and she was referred to our department and was admitted. Klebsiella pneumoniae was detected in blood culture. Although antibiotics were administered, the inflammatory response was not improved. On day 8 after hospitalization, CT revealed the aneurysm increased. Therefore, surgery was performed. Aneurysm was observed adjacent to the celiac artery. The excised aorta included the descending thoracic aorta and the superior mesenteric artery, and was replaced with a rifampicin-soaked Vasctec Gelweave 24 mm vascular graft with branches. After hemostasis, omental implantation was performed around the vascular graft. Before surgery, sufficient antibiotics administration is desirable to bring the infection under control. However, if infection is uncontrollable with progressive enlargement of the aneurysm, as in this case, surgery is unavoidable. A combination of treatments was successful.

Large mycotic pseudoaneurysm of the left circumflex treated with antibiotics and covered stent

Coronary artery mycotic aneurysms are rare complications of infective endocarditis. They are usually managed surgically with excision of the aneurysm. This surgical procedure has high morbidity and mortality. We report a case of a giant mycotic coronary aneurysm following infective endocarditis which was treated with intravenous antibiotics and covered stent. This case highlights a new treatment modality in critically ill patients.

Infected false aneurysm caused by hematogenous dissemination of Staphylococcus aureus after the use of vaginal tampons

The use of vaginal tampons during menstruation may be associated with the proliferation of bacteria on their uneven surface, unless the instructions for use provided by the manufacturer are followed. A healthy young woman presented with a false aneurysm of infectious origin, caused by Staphylococcus aureus, in connection with the use of vaginal tampons. The aneurysm manifested after the menstruation when tampons were used and during which the patient experienced an untreated feverish epizode. Vaginal colonies of Streptococcus and Staphylococcus are present in nearly 40% of healthy menstruating women. Staphylococcal septicemia with the subsequent appearance of an arterial infected false aneurysm in a formerly healthy woman has not yet been described in relation to the use of vaginal tampons.

Burkholderia pseudomallei meningitis following inadequate treatment of melioidotic mycotic aneurysm

We report a 64-year-old man presenting with meningitis caused by Burkholderia pseudomallei predisposed by persistent aortic graft infection following inadequate treatment of a melioidotic mycotic aneurysm. The relapse of melioidosis presenting as acute meningitis is a unique event. Successful treatment of deep-seated melioidosis can only be achieved when robust antimicrobial therapy is combined with appropriate surgical debridement.

[Case with hepatic artery aneurysm discovered after suffering from infectious endocarditis]

A 53-year-old man suffering from infectious endocarditis developed a rupture of the mitral valve tendinous cord. Consequently a mitral valvoplasty was performed. Forty days later, the patient presented with sudden and severe epigastralgia and hematemesis, and was rushed to our hospital. An arterial phase of an abdominal contrast-enhanced CT showed a mass 3 cm in diameter which was strongly enhanced along the side of the hepatic portal region and therefore it was thought to be an aneurysm. An abdominal angiography revealed an aneurysm of the right hepatic artery. As a result, an embolization with coils was performed. Nine months after treatment, CT examination of the abdomen revealed that the aneurysm had completely disappeared.

Perigraft infections due to Salmonella after abdominal aortic aneurysm repair

A 70-year-old man with abdominal aortic aneurysm repair presented with fever accompanied by rigors and abdominal pain one month after the procedure. Radiological investigations showed a perigraft collection. The collection was drained and the abscess cavity was lavaged. Cultures of pus and blood both yielded Group D Salmonella (non-typhi), which was treated with ceftriaxone and ciprofloxacin. The patient was followed-up for the past eight months without any further symptoms. Perigraft infections post abdominal aortic aneurysm repair could be caused by enteric organisms and must be treated with long-term appropriate antibiotics, depending on the microbiological finding, besides surgical drainage and lavage.

[Mycotic aneurysm of the abdominal aortic due to Salmonella enterica serotype enteritidis: a case report]

Bacteraemia due to non Typhi Salmonella is frequent in human immunodeficiency virus (HIV infected patients). Focal vascular complications especially in patients with artheriosclerosis are rarely reported. We report the case of patient who presented a mycotic aneurysm of the abdominal aortic due to Salmonella enterica serotype enteritidis. Despite the chirurgical treatment associated with antibiotherapy, the patient evolution was fatal.

Endovascular repair of a ruptured mycotic aneurysm of the common iliac artery

This report describes the case of a ruptured mycotic aneurysm of the left common iliac artery, successfully treated with endovascular stent-grafting. A 64-year-old woman underwent diagnostic coronary angiography complicated by an infected hematoma of the left groin. Seven days later, she developed methicillin-resistant Staphylococcus aureus septicemia and CT scan evidence of perivascular inflammation around the left common iliac artery. This was followed by rupture of a mycotic aneurysm of the left common iliac artery. The lesion was successfully treated with a stent-graft and prolonged antibiotic therapy, and the patient remains free of infection 10 months later. Accumulating evidence suggests that endovascular repair can be used safely for the repair of ruptured infected aneurysms.

Ruptured mycotic aneurysm presenting initially with bacterial meningitis

Infections of the major vessels can result in the formation of mycotic aneurysms, which can ultimately rupture and can be associated with a high mortality rate. Mycotic aneurysms can pose a diagnostic dilemma for the clinicians and successful treatment of this condition often requires a very high index of suspicion. We report an unusual case of a 65-year-old black female who initially presented with bacterial meningitis due to Streptococcus pneumoniae and 1 week later died from a ruptured undetected mycotic aneurysm. A similar case, in which a mycotic aneurysm initially presented with bacterial meningitis, could not be found in the literature.

Endovascular treatment of primary infectious aneurysm in childhood: a case report

Infectious aneurysms constitute 4% of all intracranial aneurysms. The microorganisms responsible are most commonly streptococcus viridans, staphylococcus aureus and combined bacterial infections. Nonetheless, cases with no reproduction in their cultures are rather frequent. A 6-year-old patient admitted with complaints of sudden headache, nausea, vomiting and high temperature. Intracerebral hematoma and saccular aneurysm located at the distal posterior cerebral artery were diagnosed as a result of the laboratory investigations and neuroradiological examinations. Infectious aneurysm was considered due to the clinical findings, morphology and location of the aneurysm. Although the causative microorganism was detected in blood culture, no focus could be detected. The aneurysm was hindered by endovascular intervention. In this manuscript, we discuss the infrequently seen childhood infectious aneurysm in the light of the pertinent literature.