Emergency Department Diagnosis of Multiple Mycotic Aneurysms in an HIV-Positive Patient Using Point-of-Care Ultrasound

Piyachat Sasipattarapong,Emily Johnson,Samuel Beckerman,Dana Sajed

doi:10.7759/cureus.21620

Abstract

We report the case of a transgender woman with HIV (CD4 349), shortness of breath, and chest pain, who was found to have multiple mycotic aortic aneurysms by point-of-care ultrasound (PoCUS). This report highlights the utility of point-of-care ultrasonography in the diagnosis and management of this rare clinical entity.Multiple mycotic aortic aneurysms and purulent pericarditis are uncommon. They have high morbidity and mortality and are associated with immunocompromised states (e.g., HIV). Diagnosis of the mycotic aneurysm, and its precursor, infectious aortitis, can be challenging, and delays in care can lead to poor outcomes. Often, as described in this case report, making the diagnosis requires a high clinical suspicion, multiple imaging modalities, and laboratory studies.

Highlights

Mycotic aortic aneurysm, infectious aortitis, and purulent pericarditis are rare clinical entities with established links to HIV infection and immunocompromised states [1,2]
We present the case of an HIV-positive transgender female with an innominate artery mycotic aneurysm diagnosed with computed tomography (CT), as well as mycotic abdominal aortic aneurysms (AAA) first identified using point-of-care-ultrasound (PoCUS) in the Emergency Department (ED)
CT angiography is considered the method of choice for diagnosing mycotic aortic aneurysms, in one published case series, nearly 18% of cases were initially diagnosed by ultrasound [28]

Summary

Introduction

Infectious aortitis, and purulent pericarditis are rare clinical entities with established links to HIV infection and immunocompromised states [1,2]. We present the case of an HIV-positive transgender female with an innominate artery mycotic aneurysm diagnosed with computed tomography (CT), as well as mycotic abdominal aortic aneurysms (AAA) first identified using point-of-care-ultrasound (PoCUS) in the Emergency Department (ED). This case highlights the importance of utilizing PoCUS to diagnose vascular emergencies and improve patient management. The differential diagnosis offered by the radiologists included a mycotic aneurysm given the patient’s established HIV-positive status and a lack of imaging evidence to suggest significant atherosclerotic disease (Figure 1). One month after her presentation in the ED, during a routine one-week outpatient follow-up, the patient reported feeling well

Discussion

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Disclosures