A real dilemma: Management of multiple mycotic visceral aneurysms revealing severe endocarditis

Abstract

We present a case of endocarditis, which manifested as an acute-onset of abdominal pain, due to multiple mycotic visceral aneurysms in a 31-year-old man. We initially thought that the pain had a surgical visceral aetiology. However, following a computed tomography scan of the abdomen, he was subsequently found, to have multiple mycotic visceral aneurysms including: two aneurysms in two branches of the superior mesenteric artery; two mycotic aneurysms in the left renal artery associated with bilateral renal and splenic infarcts. Further investigations confirmed that the symptoms were related to mutilated mitral and aortic valves with a high risk of embolization. Our case highlights the surgical priority between repairing the life-threatening multiple aneurysms and the mitral and aortic valves that caused an endocarditis. First, we repaired the mycotic aneurysms by ligation and/or excision. This was then followed by replacement of the aortic and mitral valves. The patient recovered remarkably well.