Lower extremity mycotic aneurysm in a patient with Listeria monocytogenes – associated prosthetic valve endocarditis

Abstract

Introduction. Listeria monocytogenes is a rare etiology of infectious endocarditis with only 30 cases of prosthetic valve and about twice as many native valve infections described in the literature. We describe an unusual presentation of an endovascular embolic phenomenon with associated lower extremity mycotic aneurysm due to Listeria monocytogenes prosthetic aortic valve and aortic endograft infection. Case presentation. This is a case of an elderly gentleman with prior history of bioprosthetic aortic valve placement and aortic arch repair who was admitted with several weeks of constitutional symptoms and left lower leg pain. Diagnostic work-up was consistent with thrombosed popliteal artery aneurysm. Blood cultures were positive for Listeria monocytogenes. A transesophageal echocardiogram revealed vegetation on the bioprosthetic valve. The patient underwent arterial bypass and ligation of the aneurysm as well as redoing of his aortic valve and aortic graft replacement. Histopathology of the aortic valve was remarkable for acute inflammation and Gram-positive coccobacilli and bacilli occupying intracellular spaces. The results of broad-range bacterial 16S rRNA PCR and sequence analysis of unfixed aortic valve tissue confirmed detection of L. monocytogenes. Conclusion. Infective endocarditis attributable to species of the genus Listeriais a rare entity. As such, there are no specific guidelines for treatment of Listeria monocytogenesendocarditis. However, combination of penicillin or ampicillin with gentamicin is the most acceptable approach described in the literature. Our patient was treated with ampicillin and gentamicin for 6 weeks followed by life-long amoxicillin suppression therapy. The patient remained asymptomatic at a 6 months follow up visit.

Listeria monocytogenes-associated endovascular infections: A study of 71 consecutive cases

“…Endovascular infections have also been reported. Altogether, 72 case reports of Lmassociated endocarditis related to have been reported worldwide since 1955, along with 47 cases with Lm-associated vascular infections (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). There are reviews compiling these heterogeneous cases, but the clinical presentation, treatment and outcome of Lm-associated endovascular infections remain unclear (8,14,19).…”

Multiple liver abscesses secondary toListeria monocytogenescomplicated by hepatic artery mycotic aneurysm

“…Almost all cases reported have occurred in elderly patients with a male predominance, and most involved aortic and common iliac arteries. Among non-aortic aneurysms, none involved underlying hardware and most occurred in iliac, femoral and popliteal arteries, with only one case each involving the inferior mesenteric, superior mesenteric and internal carotid arteries was reported4 10–17 (table 2). We thus report the first known case of common hepatic artery aneurysm due to L. monocytogenes .…”

First case of aorto‑bi‑iliac endograft thrombotic infection by Listeria monocytogenes: A case report

“…Although only a few cases of endograft infections caused by L. monocytogenes, for example, two cases of infective endocarditis via L. monocytogenes (one of which was complicated by a distal popliteal embolization of a mycotic aneurysm) and one case of thrombotic infection of the vascular graft of the right leg, have been reported (2,(4)(5)(19)(20)(21)(22)(23)(24), to the best of our knowledge no case of aortic endograft associated with thrombotic infection has ever been reported, making sure that our case is novel. Certain risk factors, including immunosuppression, immunization against human papilloma virus in vaccinated subjects, infective endocarditis, HIV infection, intravenous drug use, giant cell aortic aneurysm and sepsis, as well as the presence of aneurysm, may predispose a patient to L. monocytogenes endograft infection (11,25,26).…”