MYCOTIC ANEURYSM PRESENTING AS ACUTE PYELONEPHRITIS

This report describes a 56-year-old man with a ruptured infected abdominal aortic aneurysm secondary to Salmonella bacteremia, initially presenting as acute pyelonephritis. Spike fever with severe back pain continued despite empiric antibiotic treatment at a local hospital. Hypotension with a sudden hemoglobin drop was observed on the second hospitalization day. Abdominal computed tomography to further examine the bleeding focus confirmed a rupture of the mycotic abdominal aortic aneurysm. This case was successfully treated through prompt surgical intervention and aggressive protracted antibiotic therapy. The case presented herein raises concerns about the uncommon but life-threatening mycotic aneurysm presented initially as acute pyelonephritis. Early diagnosis and appropriate surgical and antibiotic treatment of the Salmonella mycotic aortic aneurysm is crucial for a satisfactory outcome.     

Double clostridial mycotic aneurysms of the aorta

Mycotic aortic aneurysm continues to present challenging and difficult management issues with a significant morbidity and mortality. The offending organism in the etiology of this aneurysm can be variable and unusual. The first report of two mycotic aortic aneurysms caused by Clostridium septicum in the same patient is described here. Presentation and management as well as conditions commonly associated with Clostridium septicum infection and a review of all clostridial mycotic aortic aneurysms in the English literature are discussed.     

Abdominal infectious aortitis caused by Streptococcus pneumoniae: a case report and literature review

We report a case of a 75-year-old man who had been complaining of fever and pelvic pain for 3 weeks. First angio-computed tomography (CT) characteristics and blood culture led to suspicion of a pneumococcal-infected aortic aneurysm, which however was not confirmed by the surgeon. The abdominal infectious aortitis caused by Streptococcus pneumoniae was affirmed by a second angio-CT performed 7 days later. Without further delay, the patient underwent surgery for resection of mycotic aneurysm and in situ reconstruction with aortobiiliac homograft, in association with antibiotics. He died 10 days after the surgery as a result of severe sepsis in a polyvalent intensive care unit. This case report highlights the severity of this pathology. We reviewed the relevant literature related to Streptococcal pneumoniae mycotic aneurysm located in the abdominal aorta, including 29 more cases. Various microorganisms have already been associated with mycotic aneurysms, including S pneumoniae. Infectious aortitis remains a rare disease. It is extremely important to establish an early diagnosis but it may be delayed because clinical manifestations are usually nonspecific. However, if left untreated it is always lethal. Antibiotic in combination with complete surgical excision of the infected aorta is the treatment of reference. This therapeutic association dramatically improved patient survival.     

Clostridium septicum-infected aortic aneurysm or graft is a deadly diagnosis

BackgroundClostridium septicum is an anaerobic, motile, spore-forming, toxin-producing gram-positive bacillus that can lead to rapidly progressive gas gangrene due to the release of alpha toxin. Aortic aneurysm secondary to C. septicum infection is a rare condition with 60 cases reported in the literature; however, we have recently treated several patients with the condition in our large tertiary care and aortic center.MethodsBlood and tissue culture results collected between January 2005 and January 2018 and maintained in the microbiology laboratory database at the Cleveland Clinic were reviewed to identify those with C. septicum reported. Each was reviewed to determine radiographic or histopathologic correlation with aortic disease.ResultsSeven cases of C. septicum aortitis were reviewed. Underlying malignant disease was found in four cases and a history of remote malignant disease in one case. The most common location for infection was the infrarenal abdominal aorta. Vascular surgery had previously been performed in three of the cases. Five of the seven patients underwent operative repair. All patients were treated with β-lactam antibiotics. The two patients who did not undergo an operation died, which is consistent with the 100% mortality described in the literature. Of the five patients who underwent an operation, there was only one documented survivor and one was lost to follow-up.ConclusionsIn the largest reported case series, only a small percentage of patients with C. septicum-infected aortic aneurysms survived >1 year. In the patients described, those who did not receive an operation had 100% mortality. Earlier recognition and prompt operation with appropriate antimicrobial therapy are needed to improve the outcome of patients diagnosed with this rare infection.     

Mycotic aneurysm of the abdominal aorta with retroperitoneal abscess: successful endovascular repair

Mycotic aortic aneurysms are rare. Improved diagnostic procedures, appropriate antibiotic treatment, and safe surgical techniques have reduced the high mortality associated with bacterial aortitis. However, definite evidence-based conclusions with regard to the surgical strategy cannot be drawn from the data available in the published literature. We report successful endovascular repair of a mycotic abdominal aortic aneurysm. Endovascular treatment may offer a benefit, especially in critically ill patients.     

Successful treatment of myocotic thoracic aortic aneurysm by in situ graft replacement with omental wrapping

Mycotic thoracic aortic aneurysm is a fatal disease. We report a case of a 67-year-old man presenting with contained rupture of a mycotic thoracic aortic aneurysm. Urgent in situ graft replacement was successfully performed with omental wrapping to prevent postoperative graft infection.     

Clostridium septicum: A usual suspect? Aortic rupture following right hemicolectomy: A case report

IntroductionThere is a known association between Clostridium Septicum, mycotic aneurysm and colon neoplasm.Case presentationWe report the case of a 90 year old female admitted with abdominal pain to the general surgery unit. Admission CT scan demonstrated a thick walled caecum and pericaecal inflammation suspicious for a perforated carcinoma. This was subsequently confirmed at colonoscopy with biopsy demonstrating a poorly differentiated adenocarcinoma. A laparoscopic right hemicolectomy was completed the following week after perioperative workup and intravenous antibiotic therapy. On the 9th postoperative day, fever and rising inflammatory markers prompted repeat abdominal CT scan which demonstrated a mycotic aneurysm of the upper abdominal aorta. After discussion with the vascular surgery and infectious diseases team, along the patient and family, the decision was made to palliate. The patient died at home from presumed spontaneous rupture two weeks after discharge.DiscussionMycotic aneurysm in colonic malignancy is a rare and often lethal complication. C. Septicum is causative in over 70% of cases with concomitant colonic malignancy.ConclusionMycotic aneurysm should be considered in any deteriorating patient with concomitant colonic malignancy.     

Mycotic aneurysm of the infrarenal abdominal aorta infected by Clostridium septicum: a case report of surgical management and review of the literature

We report a surgical case of mycotic aneurysm of the infrarenal abdominal aorta infected by Clostridium septicum. The patient was first treated with an in situ prosthetic graft replacement. When the infection recurred 5 weeks after the aortic surgery, the patient was successfully treated by transposition of rectus abdominis muscle flap around the graft. Only 19 cases of mycotic aneurysm or aortic dissection caused by Clostridium septicum have been reported. Ten of 12 patients who underwent vascular surgery survived, whereas all 7 patients who did not undergo surgery died. Surgical treatment should be undertaken since the surgical results seem satisfactory.     

Mycotic aneurysm presenting as acute pyelonephritis

This report describes a 56-year-old man with a ruptured infected abdominal aortic aneurysm secondary to Salmonella bacteremia, initially presenting as acute pyelonephritis. Spike fever with severe back pain continued despite empiric antibiotic treatment at a local hospital. Hypotension with a sudden hemoglobin drop was observed on the second hospitalization day. Abdominal computed tomography to further examine the bleeding focus confirmed a rupture of the mycotic abdominal aortic aneurysm. This case was successfully treated through prompt surgical intervention and aggressive protracted antibiotic therapy. The case presented herein raises concerns about the uncommon but life-threatening mycotic aneurysm presented initially as acute pyelonephritis. Early diagnosis and appropriate surgical and antibiotic treatment of the Salmonella mycotic aortic aneurysm is crucial for a satisfactory outcome.     

Multiple Mycotic Aortic Aneurysms due to <Emphasis Type="Italic">Streptococcus pneumoniae</Emphasis>

Primary pneumococcal aortic mycotic aneurysms are rare clinical entities. Only a few cases have been reported in the literature. Extremely rare presentation is the occurrence of three simultaneous aneurysms. Treatment usually necessitates intravenous antibiotherapy combined with staged surgical interventions. This report highlights the case of a 52-year-old man with multiple Streptococcus pneumoniae mycotic aneurysms that were simultaneously and successfully treated during a one-stage surgical procedure. The aorta may be prone to infection, especially when its intima is structurally altered by pathologic processes like atherosclerosis, inflammation or trauma. Mycotic aneurysm is a rare but serious vascular condition needing urgent medical and surgical attention because of potential lethal complications.     

Mycotic aneurysm of the suprarenal aorta secondary toStreptococcus pneumoniae: An unusual pathogen

Mycotic aneurysms of the suprarenal aorta are rare lesions, accounting for less than 1% of aortic reconstructions for aneurysmal disease. The bacteriology of these lesions differs from the infrarenal aneurysms and primarily consists of Gramnegative organisms. We report an unusual case of an 87-year-old man successfully treated for a ruptured mycotic suprarenal aortic aneurysm caused byStreptococcus pneumoniae. We have not seen a previously reported case where this pathogen has been associated with a suprarenal mycotic aneurysm. The unique bacteriology of these aneurysms is reviewed along with theories of etiology and their classification. The current management of these aneurysms is summarized.     

In situ repair of mycotic abdominal aortic aneurysms with rifampin-bonded gelatin-impregnated Dacron grafts: A preliminary case report

Treatment of mycotic aortic aneurysm by excision and extraanatomic bypass is difficult to apply when the infectious process involves the visceral arteries. On the basis of experimental studies in our laboratory that demonstrated prolonged antistaphylococcal activity of rifampin-bonded, gelatin-impregnated Dacron grafts after implantation in the arterial circulation, this conduit was successfully used for in situ replacement of a native aortic infection in two patients. Both patients had fever, leukocytosis, abdominal or back pain, and a computed tomographic scan that demonstrated contained rupture of a mycotic aneurysm. Preoperative computed tomography guided aspiration and culture of periaortic fluid from one patient grew Staphylococcus aureus. Treatment consisted of prolonged (6 weeks) culture-specific parenteral antibiotic therapy, excision of involved aorta, oxychlorosene irrigation of the aortic bed, and restoration of aortic continuity by in situ prosthetic replacement. A preliminary right axillobifemoral bypass was performed in the patient who had an infection involving the suprarenal and infrarenal aorta. In both patients intraoperative culture of aorta wall recovered S. aureus. Patients were discharged at 20 and 21 days. Clinical follow-up and computed tomographic imaging of the replacement graft beyond 10 months after surgery demonstrated no signs of residual aortic infection. In the absence of gross pus and frank sepsis, the use of an antibiotic-bonded prosthetic graft with antistaphylococcal activity should be considered in patients who have arterial infections caused by S. aureus when excision and ex situ bypass are not feasible. (J Vasc Surg 1996;24:472-6.)     

Cryptic mycotic abdominal aortic aneurysms: diagnosis and management

The incidence of cryptic mycotic abdominal aortic aneurysms has relatively increased since antibiotic therapy has become available. The causative organism is the salmonella group in about 50 per cent of cases. This diagnosis should be strongly entertained in patients with fever of unknown origin, vague abdominal pain, and progressive appearance of a pulsatile abdominal mass. Aortography may be helpful in establishing the diagnosis. Some postoperative graft infections may be due to unrecognized cryptic mycotic infection of the aorta and not from external contamination, as previously supposed. Construction of an axillofemoral bypass graft through clean tissue is advised for the successful treatment of the grossly infected infrarenal aortic aneurysm. Three surviving patients with cryptic mycotic abdominal aortic aneurysms are added to the sixteen surviving patients already reported in the literature.     

Once bitten, twice shy: an unusual case report of a mycotic aortic aneurysm

Primary mycotic aneurysms of the aorta are a rare, but potentially lethal condition comprising less than 1% of all aortic aneurysms. All age groups are affected but patients younger than 50 years are most susceptible. Organisms commonly implicated in aortitis and mycotic aortic aneurysms include Salmonella species and Staphylococcus aureus(1). We present the first case report of a primary aortic mycotic aneurysm caused by Capnocytophaga canimorsus, a commensal organism found in the mouth of dogs and cats and occasionally associated with serious human infections.     

Evaluation of treatment of lung cancer combined with the disease which has needed a semi-emergency operation

Six cases of lung cancer combined with the disease which has needed semi-emergency operation, two cases of unstable angina, two of ileus due to colon cancer, one of impending rupture of abdominal aortic aneurysm and one of purulent cholecystitis with cholelithiasis, were discussed. Mean age was 62.0 years (range, 36 to 73); four were male and two were female. Case 1 and 2 were admitted with anterior chest pain, Case 3 with lumbago and abdominal pain, Case 4 and 5 with an abnormal shadow on chest x-ray film and Case 6 with abdominal pain. Of the two with unstable angina, one was operated on with right upper lobectomy during the first months after aorto-coronary bypass. Of the two with colon cancer, one was operated on with right upper lobectomy during about 5 weeks after right hemi-colectomy. Case 3 with abdominal aortic aneurysm operated on with left upper lobectomy during 4 weeks after replacement of abdominal aorta. Case 4 with cholecystitis was operated on with left pneumonectomy during about 3 weeks after cholecystectomy. The postoperative course of 4 cases and the post-chemotherapy condition of 2 cases were uneventful.     

Bacteroides <Emphasis Type="Italic">fragilis</Emphasis> aortic arch pseudoaneurysm: case report with review

We present a case of 58-year-old woman with underlying diabetes mellitus, hepatitis C virus-related liver cirrhosis, and total hysterectomy for uterine myoma 11 moths ago, who was diagnosed ruptured aortic arch mycotic pseudoaneurysm after a certain period of survey for her unknown fever cause. After emergent surgery with prosthetic graft interposition, all her blood cultures and tissue cultures revealed pathogen with Bacteroides fragilis. Although mycotic aneurysms have been well described in literatures, an aneurysm infected solely with Bacteroides fragilis is unusual, with only eight similar cases in the literature. Here we reported the only female case with her specific clinical and management course and summarized all reported cases of mycotic aneurysm caused by Bacteroides fragilis to clarify their conditions and treatments, alert the difficulty in diagnosis, and importance of highly suspicious.     

猪霍乱沙门菌所致人感染性动脉瘤的腔内治疗

目的 评价猪霍乱沙门菌所致人感染性动脉瘤的诊断治疗方法.方法 回顾性分析2000年1月至2008年12月收治的8例猪霍乱沙门菌感染性动脉瘤的诊断治疗方法及效果.结果 感染性腹主动脉瘤6例,胸主动脉瘤和胭动脉瘤各1例,均行人工血管内支架腔内修复术;放置直型人工血管内支架6例,分叉型人工血管内支架2例,手术成功率为100%,无围手术期30 d内死亡或并发症发生;所有患者均恢复满意,出院后口服抗菌药物,随访时间15～36个月,4例疗效满意,影像学及实验室检查无感染复发征象,3例感染复发行局部感染灶清创引流后痊愈,1例术后3个月因腹主动脉瘤破裂死亡.结论 猪霍乱沙门菌是侵袭性和毒力较强的菌株,对于猪霍乱沙门菌感染性动脉瘤,腔内修复、应用抗菌素并密切随访,是一种可供选择的治疗方式.     

Molecular diagnosis of nonaneurysmal infectious aortitis

We report a 79-year-old patient who presented with a fever and abdominal pain. The patient was initially thought to have a retroperitoneal fibrosis or inflammatory abdominal aortitis in a normal-sized caliber aorta. Broad-range polymerase chain reaction (PCR) and DNA sequencing revealed the presence of Enterobacter. We finally diagnosed nonaneurysmal infectious aortitis, and we performed a successful surgical resection. Establishing a diagnosis of aortic infection before formation of an aneurysm is difficult. The molecular diagnostic technique was particularly useful in specifying the microbial species and diagnosis.     

Spontaneous infective spondylitis and mycotic aneurysm: incidence, risk factors, outcome and management experience

Infective spondylitis occurring concomitantly with mycotic aneurysm is rare. A retrospective record review was conducted in all cases of mycotic aneurysm from January 1995 to December 2004, occurring in a primary care and tertiary referral center. Spontaneous infective spondylitis and mycotic aneurysm were found in six cases (10.3% of 58 mycotic aneurysm patients). Neurological deficit (50% vs. 0; P < 0.001) is the significant clinical manifestation in patients with spontaneous infective spondylitis and mycotic aneurysm. The presence of psoas abscess on computed tomography (83.3% vs. 0; P < 0.001) and endplate destruction on radiography (50% vs. 0; P < 0.001) are predominated in patients with spontaneous infective spondylitis and mycotic aneurysm. Of these six patients, four with Salmonella infection received surgical intervention and all survived. Another two patients (one with Streptococcus pyogenes, another with Staphylococcus aureus) received conservative therapy and subsequently died from rupture of aneurysm or septic shock. Paravertebral soft tissue swelling, presence of psoas abscess and/or unclear soft tissue plane between the aorta and vertebral body in relation to mycotic aneurysm may indicate a concomitant infection in the spine. In contrast, if prevertebral mass is found in the survey of spine infection, coexisting mycotic aneurysm should be considered.     

Aortic involvement in relapsing polychondritis

Objective

To assess prevalence of aortic involvement in relapsing polychondritis (RP) patients; to evaluate clinical features and long-term outcome of RP patients exhibiting aortitis, aortic ectasia and/or aneurysm.