Occult Bacteraemia and Aortic Graft Infection: A Wolf in Sheep’s Clothing

E Trautt,P Newton,S Thomas,J Ghosh,A Cockcroft

doi:10.1155/2013/968542

Abstract

We report a case of late-onset aortic prosthetic vascular graft infection. We stress the importance of maintaining a high index of suspicion for any patient presenting with fever on the background of in situ prosthetic material. We present the difficulties in managing these extremely complicated, often life and limb threatening infections and suggest that a multidisciplinary team approach, involving specialist centre referral, may be key to success. We highlight the difficulties in diagnosing late-onset PVGI, where presentation can be subacute with subtle signs and confusing microbiology. In this case the presentation was pyrexia of unknown origin with multiple positive blood cultures isolating a variety of gut-associated organisms; a wolf in sheep's clothing.

Highlights

Prosthetic vascular graft infection (PVGI) is a significant complication of arterial reconstructive surgery [1]
The relative risk of PVGI is low, the clinical consequences of an infected vascular graft can be catastrophic for the patient, with an associated operative morbidity of 40–70% and a recognized mortality rate of 30–50%
We describe an unusual presentation of late-onset aortic graft infection which stresses the importance of maintaining a high index of suspicion in any patient with unexplained fevers and underlying in situ prosthetic material

Summary

Background

Prosthetic vascular graft infection (PVGI) is a significant complication of arterial reconstructive surgery [1]. We describe an unusual presentation of late-onset aortic graft infection which stresses the importance of maintaining a high index of suspicion in any patient with unexplained fevers and underlying in situ prosthetic material. In management of this case we demonstrate effective clinical use of Daptomycin and highlight the need for national consensus guidelines to guide the management of these complex infections. He presented to the clinic with night sweats, intermittent fevers, rigors, lethargy, weight loss, poor appetite, and generalised arthralgias He described a change in the bowel habit over the previous few months with constipation and mild abdominal discomfort.

Blood Lactobacillus species

Discussion

Findings

Profunda femoris