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Group B streptococcus mycotic aneurysm of the abdominal aorta: report of a case and review of the literature.

Thawait SK, Akay A, Jhirad RH, El-Daher N - Yale J Biol Med (2012)

Bottom Line: We present the first reported case of a GBS-infected abdominal aortic aneurysm (AAA) in North America.Key clinical and imaging findings and pathologic correlation are highlighted.A relevant review of the literature is discussed, which will bring the reader up to date with this specific disease entity.

View Article: PubMed Central - PubMed

Affiliation: Yale University-Bridgeport Hospital, Yale New Haven Health System, Bridgeport, CT, USA. sthawai2@jhmi.edu

ABSTRACT
Mycotic aneurysm of the aorta is an uncommon condition, and Group B Streptococcus (GBS) is exceedingly rare in this setting. We present the first reported case of a GBS-infected abdominal aortic aneurysm (AAA) in North America. Key clinical and imaging findings and pathologic correlation are highlighted. A relevant review of the literature is discussed, which will bring the reader up to date with this specific disease entity.

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Related in: MedlinePlus

Axial contrast enhanced CT of the abdomen demonstrating an infrarenal abdominalaortic aneurysm (arrowheads). The large black arrow shows a small area of lowattenuation in the anterior right psoas muscle that was confirmed to be acontained rupture during surgery.
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Figure 1: Axial contrast enhanced CT of the abdomen demonstrating an infrarenal abdominalaortic aneurysm (arrowheads). The large black arrow shows a small area of lowattenuation in the anterior right psoas muscle that was confirmed to be acontained rupture during surgery.

Mentions: A 75-year-old Caucasian male presented with 2-day history of left leg swelling anddiscomfort. Review of systems was positive for mild back pain, fever, night sweats,and weight loss. Past medical history was significant for ischemic heart disease,hypertension, hyperlipidemia, and chronic obstructive lung disease. He also had a60-packs-a-year cigarette smoking history. There was no family history of AAA. Onemonth ago prior to presentation, he was treated for suspectedbronchitis/exacerbation of chronic obstructive lung disease with 1 week ofintravenous moxifloxacin (400 mg daily) as an inpatient and 1 more week of oralmoxifloxacin (400 mg daily) as an outpatient. Physical examination was significantfor 4+ pitting edema and tenderness in the left lower extremity. The patient’slaboratory workup was remarkable for elevated C-reactive protein (CRP) 23.630 mg/dl(normal value <0.8 mg/dl); elevated erythrocyte sedimentation rate (ESR) of>100mm in the first hour (normal range 0-20 mm/h); leucocytosis, white blood cellcount 14,000/cu mm (normal range, 3,000-10,000/cu mm); and neutrophilia 81 percent (normal range, 45-70 percent). Doppler ultrasound of the lower extremitiesdemonstrated extensive deep venous thrombosis (DVT) involving the left poplitealvein, left common femoral vein, and extending into the left external iliac vein.Anticoagulation was started with low-molecular weight heparin, and further imagingwas done at this time as extensive DVT raised the suspicion of malignancy. Contrastenhanced chest, abdomen, and pelvis computed tomography (CT) showed an infrarenalirregular abdominal aortic aneurysm (5.7 cm x 4.0 cm x 5.1 cm) with a containedrupture (Figures 1 and 2). A mycotic aneurysm was suspected with clinical picture offever, low back pain, leucocytosis, and the irregular CT appearance of the aneurysm.Intravenous Vancomycin 1gm every 12 hours and intravenous Piperacillin-Tazobactam3.375gm every 6 hours was started empirically.


Group B streptococcus mycotic aneurysm of the abdominal aorta: report of a case and review of the literature.

Thawait SK, Akay A, Jhirad RH, El-Daher N - Yale J Biol Med (2012)

Axial contrast enhanced CT of the abdomen demonstrating an infrarenal abdominalaortic aneurysm (arrowheads). The large black arrow shows a small area of lowattenuation in the anterior right psoas muscle that was confirmed to be acontained rupture during surgery.
© Copyright Policy - open access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3313544&req=5

Figure 1: Axial contrast enhanced CT of the abdomen demonstrating an infrarenal abdominalaortic aneurysm (arrowheads). The large black arrow shows a small area of lowattenuation in the anterior right psoas muscle that was confirmed to be acontained rupture during surgery.
Mentions: A 75-year-old Caucasian male presented with 2-day history of left leg swelling anddiscomfort. Review of systems was positive for mild back pain, fever, night sweats,and weight loss. Past medical history was significant for ischemic heart disease,hypertension, hyperlipidemia, and chronic obstructive lung disease. He also had a60-packs-a-year cigarette smoking history. There was no family history of AAA. Onemonth ago prior to presentation, he was treated for suspectedbronchitis/exacerbation of chronic obstructive lung disease with 1 week ofintravenous moxifloxacin (400 mg daily) as an inpatient and 1 more week of oralmoxifloxacin (400 mg daily) as an outpatient. Physical examination was significantfor 4+ pitting edema and tenderness in the left lower extremity. The patient’slaboratory workup was remarkable for elevated C-reactive protein (CRP) 23.630 mg/dl(normal value <0.8 mg/dl); elevated erythrocyte sedimentation rate (ESR) of>100mm in the first hour (normal range 0-20 mm/h); leucocytosis, white blood cellcount 14,000/cu mm (normal range, 3,000-10,000/cu mm); and neutrophilia 81 percent (normal range, 45-70 percent). Doppler ultrasound of the lower extremitiesdemonstrated extensive deep venous thrombosis (DVT) involving the left poplitealvein, left common femoral vein, and extending into the left external iliac vein.Anticoagulation was started with low-molecular weight heparin, and further imagingwas done at this time as extensive DVT raised the suspicion of malignancy. Contrastenhanced chest, abdomen, and pelvis computed tomography (CT) showed an infrarenalirregular abdominal aortic aneurysm (5.7 cm x 4.0 cm x 5.1 cm) with a containedrupture (Figures 1 and 2). A mycotic aneurysm was suspected with clinical picture offever, low back pain, leucocytosis, and the irregular CT appearance of the aneurysm.Intravenous Vancomycin 1gm every 12 hours and intravenous Piperacillin-Tazobactam3.375gm every 6 hours was started empirically.

Bottom Line: We present the first reported case of a GBS-infected abdominal aortic aneurysm (AAA) in North America.Key clinical and imaging findings and pathologic correlation are highlighted.A relevant review of the literature is discussed, which will bring the reader up to date with this specific disease entity.

View Article: PubMed Central - PubMed

Affiliation: Yale University-Bridgeport Hospital, Yale New Haven Health System, Bridgeport, CT, USA. sthawai2@jhmi.edu

ABSTRACT
Mycotic aneurysm of the aorta is an uncommon condition, and Group B Streptococcus (GBS) is exceedingly rare in this setting. We present the first reported case of a GBS-infected abdominal aortic aneurysm (AAA) in North America. Key clinical and imaging findings and pathologic correlation are highlighted. A relevant review of the literature is discussed, which will bring the reader up to date with this specific disease entity.

Show MeSH
Related in: MedlinePlus