Contained Rupture of a Small Mycotic Abdominal Aneurysm in a Patient With Infective Endocarditis.

Rafael Carlos Da Silva,Onoriode Kesiena,Navin Kumar

doi:10.7759/cureus.18963

Abstract

A contained ruptured mycotic abdominal aneurysm is one of the complications of infective endocarditis. It is a complication that physicians should entertain when patients with infective endocarditis present with a complaint of back pain. This case report aims to increase the awareness of the possibility of a rupture of a small size abdominal mycotic aneurysm. This is a 36-year-old female with a history of intravenous (IV) drug use and infective endocarditis secondary to methicillin-sensitive Staphylococcus aureus presented with acute right-sided lower back pain. Work-up revealed a contained ruptured 2.5 cm mycotic abdominal aneurysm. She had an open surgical repair of the abdominal aorta followed by a mitral valve replacement a week later and she was discharged home on antibiotics and an anticoagulant. Untreated, a mycotic aneurysm can expand quickly and has a higher likelihood of rupturing as compared to an atherosclerotic abdominal aortic aneurysm. A contained ruptured mycotic abdominal aneurysm can lead to a dramatic hemodynamic compromise when it becomes uncontained, hence it is prudent that it is acted after it is diagnosed. Most authors recommend prompt surgery for all patients irrespective of the size of the aneurysm. Younger age is a factor to consider in choosing a repair approach despite the complications associated with both open surgical and endovascular repair.

Highlights

Mycotic aortic aneurysm (MAA) is a focal dilation of the aorta due to an infection [1]
The literature comments on the increased risk of rupture of a mycotic aneurysm due to a rapid increase in size and inflammatory pathology. This case report increases the awareness of the rupture of a small-size MAA
The impression was consistent with a mycotic aneurysm with irregular lobular contours at the aortic bifurcation compatible with contained rupture

Summary

Introduction

Mycotic aortic aneurysm (MAA) is a focal dilation of the aorta due to an infection [1]. The pain was dull in nature and was worse on waking up in the morning and better with ibuprofen It did not radiate and at the time of presentation, and the severity was 7/10. Similar previous episodes, fever, urinary or fecal incontinence She had left against medical advice at another facility 10 days prior to presentation, where she was managed for endocarditis. She had a significant smoking and alcohol consumption history.

Results

Discussion

Conclusions

Disclosures