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Mycotic pseudoaneurysms complicating renal transplantation: a case series and review of literature.

Leonardou P, Gioldasi S, Zavos G, Pappas P - J Med Case Rep (2012)

Bottom Line: Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock.Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site.No recurrence was recorded during the follow-up period.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, Laikon General Hospital of Athens, 17 Ag, Thoma str,, 115 27Athens, Greece. pappasparis@hotmail.com.

ABSTRACT

Introduction: Kidney transplantation can be complicated by infection and subsequent development of mycotic aneurysm, endangering the survival of the graft and the patient. Management of this condition in five cases is discussed, accompanied by a review of the relevant literature.

Case presentations: Five patients, three men 42-, 67- and 57-years-old and two women 55- and 21-years-old (mean age of 48 years), all Caucasians, developed a mycotic aneurysm in the region of the anastomosis between renal graft artery and iliac axes. Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock. Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site. A combination of antibiotic therapy, surgery and interventional procedures was required as all kidney transplants had to be removed. No recurrence was recorded during the follow-up period.

Conclusions: A high index of suspicion is required for the timely diagnosis of a mycotic aneurysm; aggressive treatment with cover stents and/or surgical excision is necessary in order to prevent potentially fatal complications.

No MeSH data available.


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Mycotic pseudoaneurysm's (arrow left) exclusion with covered stent (right).
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Figure 1: Mycotic pseudoaneurysm's (arrow left) exclusion with covered stent (right).

Mentions: The first case is a 42-year-old Caucasian man, who was on hemodialysis after rejection of a kidney allograft of unknown etiology four years ago. Three months after nephrectomy, the patient was admitted to our hospital with diffuse pain in his right lower quadrant, acute ischemia of his right lower limb with the presence of petechiae and a systemic temperature of 38°C. Angiographic investigation revealed a pseudoaneurysm at the site of the previous arterial ligation and three balloon expandable cover stents were deployed during the same procedure to exclude the aneurysm (Figure 1). Following this interventional procedure, the patient was continuously febrile (38.5°C) and his blood examinations revealed leukocytosis. He then developed clinical signs of thromboembolism, which were confirmed by angiography (Figure 2). Subsequent treatment involved embolectomy and the histological examination of the thrombus identified mucorales hyphae. Histological examination also revealed mucorales infection of the stents. The patient underwent surgery for removal of both the mycotic aneurysm and the stents, and for construction of a suprapubic femoral-femoral by-pass. He also received amphotericin B for three months. No recurrence or any other major complication has been recorded during a follow-up period of eight years and he was able later on to undergo a kidney transplantation successfully.


Mycotic pseudoaneurysms complicating renal transplantation: a case series and review of literature.

Leonardou P, Gioldasi S, Zavos G, Pappas P - J Med Case Rep (2012)

Mycotic pseudoaneurysm's (arrow left) exclusion with covered stent (right).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3295713&req=5

Figure 1: Mycotic pseudoaneurysm's (arrow left) exclusion with covered stent (right).
Mentions: The first case is a 42-year-old Caucasian man, who was on hemodialysis after rejection of a kidney allograft of unknown etiology four years ago. Three months after nephrectomy, the patient was admitted to our hospital with diffuse pain in his right lower quadrant, acute ischemia of his right lower limb with the presence of petechiae and a systemic temperature of 38°C. Angiographic investigation revealed a pseudoaneurysm at the site of the previous arterial ligation and three balloon expandable cover stents were deployed during the same procedure to exclude the aneurysm (Figure 1). Following this interventional procedure, the patient was continuously febrile (38.5°C) and his blood examinations revealed leukocytosis. He then developed clinical signs of thromboembolism, which were confirmed by angiography (Figure 2). Subsequent treatment involved embolectomy and the histological examination of the thrombus identified mucorales hyphae. Histological examination also revealed mucorales infection of the stents. The patient underwent surgery for removal of both the mycotic aneurysm and the stents, and for construction of a suprapubic femoral-femoral by-pass. He also received amphotericin B for three months. No recurrence or any other major complication has been recorded during a follow-up period of eight years and he was able later on to undergo a kidney transplantation successfully.

Bottom Line: Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock.Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site.No recurrence was recorded during the follow-up period.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, Laikon General Hospital of Athens, 17 Ag, Thoma str,, 115 27Athens, Greece. pappasparis@hotmail.com.

ABSTRACT

Introduction: Kidney transplantation can be complicated by infection and subsequent development of mycotic aneurysm, endangering the survival of the graft and the patient. Management of this condition in five cases is discussed, accompanied by a review of the relevant literature.

Case presentations: Five patients, three men 42-, 67- and 57-years-old and two women 55- and 21-years-old (mean age of 48 years), all Caucasians, developed a mycotic aneurysm in the region of the anastomosis between renal graft artery and iliac axes. Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock. Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site. A combination of antibiotic therapy, surgery and interventional procedures was required as all kidney transplants had to be removed. No recurrence was recorded during the follow-up period.

Conclusions: A high index of suspicion is required for the timely diagnosis of a mycotic aneurysm; aggressive treatment with cover stents and/or surgical excision is necessary in order to prevent potentially fatal complications.

No MeSH data available.


Related in: MedlinePlus