Abstract
Vascular Pythiosis caused by Pythium insiodiosum rarely involves carotid artery. A case of concealed ruptured pseudoaneurysm of the carotid artery with neck abscesses, and cerebral septic emboli is described. Patient presented with large pulsatile neck mass that failed to response to surgery, antifungals and immunotherapeutic vaccine. Residual unresectable disease leads to death in the patient. Pythiosis should be considered as a differential diagnosis of head and neck infection.
Highlights
Human pythiosis is endemic in Thailand, tropical and subtropical area of the world known to cause disease in animal and human [1]
We described the first case of concealed rupture of left carotid artery pseudoaneurysm associated para-pharyngeal abscesses with meningitis and cerebral septic emboli caused by P. insidiosum in an alcoholic patient
We report the first case of concealed rupture of large carotid artery pseudoaneurysm with parapharyngeal abscess, meningitis and cerebral septic emboli caused by P. insidiosum in an alcoholic patient
Summary
Human pythiosis is endemic in Thailand, tropical and subtropical area of the world known to cause disease in animal and human [1]. We described the first case of concealed rupture of left carotid artery pseudoaneurysm associated para-pharyngeal abscesses with meningitis and cerebral septic emboli caused by P. insidiosum in an alcoholic patient. Computer tomography of the neck showed a concealed ruptured of left external carotid artery 0.9 × 1.9 cm in size with surrounding hematoma (3.6 × 3.6 ×5.8 cm) at medial aspect of an aneurysm resulted in narrowing of the upper airway (Fig. 1A, B). On Day 6, MRI and MRA of the brain revealed pseudoaneurysm of carotid artery at left carotid-parapharyngeal spaces (2.8 × 2.0 × 3.1 cm) associated with extensive inflammation of the surrounding soft tissue resulting in mild narrowing of upper airway. On day 49, upon an outpatient visit, he had flaccid hemiparesis on the right side without other deficit He received fourth dose of PIA vaccine and continued oral itraconazole and terbinafine. On day 82, he expired at a local hospital due to complication of diseases
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