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Melioidosis mycotic aneurysm: An uncommon complication of an uncommon disease.

Li PH, Chau CH, Wong PC - Respir Med Case Rep (2014)

Bottom Line: However it is an endemic disease in Southeast Asia and Northern Australia with an expanding distribution.The morbidity and mortality of this uncommon complication remains high despite prompt diagnosis and treatment.Especially when treating persistent/recurrent melioidosis, the physician's caution to the development of mycotic aneurysms is imperative so that early treatment and surgical intervention may be considered.

View Article: PubMed Central - PubMed

Affiliation: Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong.

ABSTRACT
Melioidosis is often considered an exotic and uncommon disease in most parts of the world. However it is an endemic disease in Southeast Asia and Northern Australia with an expanding distribution. Melioidosis can involve almost any organ and can deteriorate rapidly. In this report, we describe a rapidly fatal case of a mycotic aneurysm associated with melioidosis despite aggressive antibiotic therapy. The morbidity and mortality of this uncommon complication remains high despite prompt diagnosis and treatment. Especially when treating persistent/recurrent melioidosis, the physician's caution to the development of mycotic aneurysms is imperative so that early treatment and surgical intervention may be considered.

No MeSH data available.


Related in: MedlinePlus

PET-CT showing hypermetabolic mass at the left side of the superior mediastinum, consistent with mycotic aneurysm of the aortic arch/left subclavian artery.
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fig1: PET-CT showing hypermetabolic mass at the left side of the superior mediastinum, consistent with mycotic aneurysm of the aortic arch/left subclavian artery.

Mentions: However he experienced fever and cough again three weeks after cessation of antibiotic therapy. CXR on presentation showed no new abnormalities, but blood tests again confirmed SIADH with raised inflammatory markers and B. pseudomallei septicaemia (sensitive to ceftazidime). He was restarted on ceftazidime but his symptoms and fever persisted. Ceftazidime was switched to meropenam but still without signs of clinical improvement. Serial blood cultures showed persistent B. pseudomallei septicaemia without change in antibiotic susceptibility. Whole body positron emission tomography–CT (PET-CT) was performed, which revealed a new heterogeneous hyperdense mass at the left side of the superior mediastinum associated elevated fluorodeoxyglucose (FDG) uptake, consistent with mycotic aneurysm of the aortic arch/left subclavian artery; and patchy FDG uptakes are noted within the vertebral bodies of the cervical and thoracic spine, suggestive of possible bone involvement (Fig. 1). Echocardiogram showed a structurally normal heart and no vegetations were seen. The dihydrorhodamine reduction (DHR) test revealed a low oxidative burst response.


Melioidosis mycotic aneurysm: An uncommon complication of an uncommon disease.

Li PH, Chau CH, Wong PC - Respir Med Case Rep (2014)

PET-CT showing hypermetabolic mass at the left side of the superior mediastinum, consistent with mycotic aneurysm of the aortic arch/left subclavian artery.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356043&req=5

fig1: PET-CT showing hypermetabolic mass at the left side of the superior mediastinum, consistent with mycotic aneurysm of the aortic arch/left subclavian artery.
Mentions: However he experienced fever and cough again three weeks after cessation of antibiotic therapy. CXR on presentation showed no new abnormalities, but blood tests again confirmed SIADH with raised inflammatory markers and B. pseudomallei septicaemia (sensitive to ceftazidime). He was restarted on ceftazidime but his symptoms and fever persisted. Ceftazidime was switched to meropenam but still without signs of clinical improvement. Serial blood cultures showed persistent B. pseudomallei septicaemia without change in antibiotic susceptibility. Whole body positron emission tomography–CT (PET-CT) was performed, which revealed a new heterogeneous hyperdense mass at the left side of the superior mediastinum associated elevated fluorodeoxyglucose (FDG) uptake, consistent with mycotic aneurysm of the aortic arch/left subclavian artery; and patchy FDG uptakes are noted within the vertebral bodies of the cervical and thoracic spine, suggestive of possible bone involvement (Fig. 1). Echocardiogram showed a structurally normal heart and no vegetations were seen. The dihydrorhodamine reduction (DHR) test revealed a low oxidative burst response.

Bottom Line: However it is an endemic disease in Southeast Asia and Northern Australia with an expanding distribution.The morbidity and mortality of this uncommon complication remains high despite prompt diagnosis and treatment.Especially when treating persistent/recurrent melioidosis, the physician's caution to the development of mycotic aneurysms is imperative so that early treatment and surgical intervention may be considered.

View Article: PubMed Central - PubMed

Affiliation: Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong.

ABSTRACT
Melioidosis is often considered an exotic and uncommon disease in most parts of the world. However it is an endemic disease in Southeast Asia and Northern Australia with an expanding distribution. Melioidosis can involve almost any organ and can deteriorate rapidly. In this report, we describe a rapidly fatal case of a mycotic aneurysm associated with melioidosis despite aggressive antibiotic therapy. The morbidity and mortality of this uncommon complication remains high despite prompt diagnosis and treatment. Especially when treating persistent/recurrent melioidosis, the physician's caution to the development of mycotic aneurysms is imperative so that early treatment and surgical intervention may be considered.

No MeSH data available.


Related in: MedlinePlus