A mycotic aneurysm related to Salmonella Rissen infection: a case report

Abstract

Background: Salmonella species commonly causes infection in humans and on occasion leads to serious complications, such as mycotic aneurysms. Here, we present the first case reported of a patient with a mycotic aneurysm likely secondary to Salmonella Rissen infection. Case presentation: The patient presented with 4 weeks of lower back pain, chills and a single episode of diarrhoea 2 months prior during a 14-day trip to Hong Kong and Taiwan. Magnetic resonance imaging revealed an aneurysmal left internal iliac artery with adjacent left iliacus rim-enhancing collection. A stool culture was positive for Salmonella Rissen ST 469 EBG 66 on whole genome sequencing. The patient underwent an emergency bifurcated graft of his internal iliac aneurysm and was successfully treated with appropriate antibiotics. Conclusions: This case highlights the importance of considering the diagnosis of a mycotic aneurysm in an unusual presentation of back pain with features of infection.

Isolated Mycotic Internal Iliac Artery Aneurysm Treated With a Combined Endovascular Stenting and Percutaneous Drainage Approach: A Case Report and Review of Current Literature

“…1 Isolated mycotic aneurysms of the internal iliac artery are rare and only a few cases have been described to date. 2,3 Infected aneurysms are a serious clinical condition associated with significant morbidity and mortality left untreated, therefore quick recognition and appropriate treatment are paramount. Sörelius et al (2014) described 3 diagnostic criteria for mycotic aneurysms: (1) clinical presentation (pain, fever, sepsis, or concomitant infection), (2) laboratory tests (elevation of inflammatory markers like C-reactive protein and white blood cells, or positive cultures), and (3) radiological findings on computed tomography (CT) or MRI (rapid expansion of aneurysm, saccular aneurysm, multi-lobular aneurysms, eccentric aneurysms, periaortic gas, and periaortic soft tissue mass).…”

“…1 Isolated mycotic aneurysms of the internal iliac artery are very rare and only a few cases have been reported in current literature. 2,3…”

Aneurisma infeccioso primário da aorta: série de casos e revisão da literatura

“…Early diagnosis is key to therapeutic success. 6 , 8 , 9 , 12 , 16 Classically, there is fever, 1 , 3 , 4 , 6 - 8 , 14 , 18 abdominal/lumbar pains, and a pulsating mass 1 , 4 , 6 - 8 , 14 , 18 in the presence of an infectious condition (osteomyelitis, urinary infections, tuberculosis, gastroenteritis, and soft tissue infections) 1 , 4 , 6 , 11 , 14 and/or immunosuppression caused by diseases or medications (cancer, renal failure requiring dialysis, HIV, diabetes, corticosteroids). However, asymptomatic cases can also occur.…”

“…Infectious aneurysms, formerly known as mycotic aneurysms, are rare, accounting for 1-3% of all aneurysms. 1 , 2 They most frequently affect the aorta 2 , 3 in young men, 4 the most characteristic shape is saccular, 5 and they have a greater tendency to rupture than non-infectious aneurysms. 6 , 7 The most common etiologic agents are Staphylococcus sp.…”

“… 6 - 8 Fever, pulsating mass, and abdominal pains are described classically, as are elevated inflammatory markers and positive blood cultures, but are not always present. 3 , 9 Treatment for this type of aneurysm must be initiated rapidly, with antibiotic therapy (ideally guided by cultures) and surgery. 1 , 6 - 9 Few surgeons accumulate experience with their treatment and the literature contains imprecise information on nomenclature, diagnostic criteria, and therapeutic strategies.…”