Observe and be guarded: the development and rupture of an abdominal aortic mycotic aneurysm in an afebrile hemodialysis patient with normal angiogram, and CT scan, and sterile blood cultures

Abstract

Despite the increased risk factors and a high incidence of bacteremia in hemodialysis patients, the presence of mycotic aneurysms in the hemodialysis population is virtually unknown. Only two cases have been previously reported in this population. The diagnosis is usually made by angiogram, magnetic resonance angiography, or computed tomography (CT) in the presence of bacteremia demonstrated by positive blood culture. We report a case of mycotic aneurysm in an afebrile hemodialysis patient with sterile blood cultures for whom the diagnosis was made after no aneurysm was seen on abdominal ultrasound, CT scan, or magnetic resonance angiography. After a discussion of pathophysiology, we offer some insight into why so few mycotic aneurysms are reported in the hemodialysis population.