Mycotic Pseudoaneurysm and Purulent Pericarditis Attributable to Methicillin-Resistant<i>Staphylococcus aureus</i>

Patel, Sugat; Maves, Ryan C; Barrozo, Christopher P.; Mullens, Frank; Russell, Kevin L.; Deroo, Teresa

doi:10.7205/milmed.171.8.784

Cited by 16 publications

(15 citation statements)

References 21 publications

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“…1 Aortitis or the development of aortic aneurysm in a previously healthy adult, adolescent, or child is also rare. To our knowledge, there are no reports of children or adolescents with community-acquired MRSA mycotic aortic aneurysm, and we found only 2 reports of adults with the condition: one of a 20-year-old man with an ascending aortic aneurysm, 7 and one of a 62-year-old woman with a left common iliac artery aneurysm. 8 Timely diagnosis and appropriate management led to successful outcomes in both cases.…”

Section: Discussionmentioning

confidence: 76%

Healthy Adolescent with a Mycotic Aortic Aneurysm from Community-Acquired Methicillin-Resistant Staphylococcus aureus

Naidu¹,

Quinones²,

Lutschg

et al. 2017

Texas Heart Institute Journal

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A rare condition in adults, mycotic aneurysm of the thoracic aorta is even rarer in children and adolescents.1 Diagnosing the condition is often difficult, which leads to delayed surgeries and high mortality rates.2,3 We report a case of mycotic aortic aneurysm secondary to community-acquired, methicillin-resistant Staphylococcus aureus (MRSA) in a previously healthy adolescent boy. Case ReportIn September 2013, a 15-year-old boy presented at the emergency department of his local hospital with a 4-day history of intermittent sharp pain in his upper-left chest that radiated to his back. He also reported a 2-to 3-week history of general malaise without fever. The patient's medical history included the repair of an anterior cruciate ligament tear in his right knee, made necessary after a sports injury at 13 years of age. Results of the patient's physical examination, chest radiograph, and electrocardiogram were normal. A diagnosis of musculoskeletal chest pain was made, and the patient was discharged with instructions to take ibuprofen for pain as needed. The ibuprofen only partially relieved his chest pain, so he returned to the emergency department the next day and was discharged with the same diagnosis. On the 3rd day, he returned with chest pain, a fever (temperature, 102 °F), nausea, vomiting, and worsening fatigue. He also had oral lesions suspicious for herpes labialis. His white blood cell count was 8,800/µL, with 84 polymorphs and 4 bands of neutrophils. Blood and urine samples were obtained.The patient was admitted to the hospital with the diagnosis of presumed sepsis. Vancomycin, ceftriaxone, and acyclovir were started. The chest radiograph showed normal results (Fig. 1A). The next day, the patient continued to have intermittent fever and developed nontender erythematous macules resembling Janeway lesions on his left palm. Infective endocarditis was suspected. A transthoracic echocardiogram (TTE) showed a structurally normal heart with normal left ventricular systolic function. This initial echocardiogram also showed normal dimensions of the aortic arch and proximal descending thoracic aorta. Blood cultures were positive for MRSA. On the 4th day of hospitalization, a chest radiograph showed widening of the superior mediastinum (Fig. 1B), and a computed tomographic angiogram (CTA) of the chest revealed a 4-cm saccular aneurysm involving the distal transverse aortic arch, proximal descending thoracic aorta, and proximal left subclavian artery (Fig. 2). A para-aortic arch abscess was also noted.

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Section: Discussionmentioning

confidence: 76%

Healthy Adolescent with a Mycotic Aortic Aneurysm from Community-Acquired Methicillin-Resistant Staphylococcus aureus

Naidu¹,

Quinones²,

Lutschg

et al. 2017

Texas Heart Institute Journal

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“…[1][2][3][4][5] Only one case caused by MRSA has been previously reported. 6 The patient was an otherwise healthy 20-yearold man who survived following ascending aortic replacement using a homograft and 8 weeks of antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] We hereby present the fi rst case that resulted in pulmonary trunk rupture that was caused by methicillin-resistant Staphylococcus aureus (MRSA) infection.…”

Section: Introductionmentioning

confidence: 99%

Infected aortic aneurysm, purulent pericarditis, and pulmonary trunk rupture caused by methicillin-resistant Staphylococcus aureus

Saito

Matsuura

Miyahara

et al. 2009

Gen Thorac Cardiovasc Surg

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A 66-year-old woman presented with cardiac tamponade. Pericardiocentesis revealed purulent pericarditis. Enhanced computed tomography showed a saccular aneurysm of the aortic arch. An irregularly shaped and partially enhanced mass was seen adjacent to the aneurysm, which suggested development of a mycotic pseudoaneurysm. Surgical drainage was performed through a subxiphoid incision, and continuous irrigation was commenced. On the following day, however, massive bleeding was recognized through the drains. The patient was immediately transferred to the operating theater, and extracorporeal circulation was established. A perforation 1 cm in diameter was found on the anterior surface of the pulmonary trunk, and a large amount of pus came out from the tear. The ascending aorta and the arch were found to be infected. Surgical repair was impossible due to extensive infection, and the patient died. Methicillin-resistant Staphylococcus aureus was isolated from the pericardial effusion, blood, and intraluminal thrombus of the aortic aneurysm.

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“…The term mycotic aneurysm was first used by Sir William Osler in 1885 to describe a ‘fresh fungal vegetation’ and has since been used to describe infected non-syphilitic arterial aneurysms and pseudoaneurysms, not necessarily fungal 4 5. MPAs constitute <1% of all aneurysms, and are characterised anatomically by a sac or cavity and a neck communicating with the arterial lumen 2 6.…”

Section: Discussionmentioning

confidence: 99%

“…2 5 7 Graft placement is often complicated by graft infection and endovascular coiling increases the likelihood for necrosis and abscess formation 6. There is no role for conservative therapy without removal of the infective focus 7 10.…”

Section: Discussionmentioning

confidence: 99%

Mycotic pseudoaneurysm by vancomycin-intermediateStaphylococcus aureus: a rare cause of persistent bacteraemia

et al. 2015

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SUMMARYPseudoaneurysms are vessel wall ruptures, that are often mistaken for deep vein thrombosis (DVT). A middle-aged man presented with right leg pain, swelling and erythema. His history was significant for persistent Staphylococcus aureus bacteraemia. Ultrasound revealed subacute DVT and laboratory parameters were suggestive of sepsis. He was started on intravenous heparin and antimicrobials. Owing to persistent anaemia despite blood transfusion, MRI of the right thigh was obtained. It revealed a 13×17 cm superficial femoral artery infected mycotic pseudoaneurysm (MPA) with a fresh haematoma. The patient underwent arterial ligation and extensive debridement. Intraoperative cultures revealed daptomycin-resistant vancomycin-intermediate S. aureus (VISA) and he was managed with 6 weeks of intravenous ceftaroline. MPAs are most common in the femoral artery and form <1% of aneurysms. Therapy involves surgical debridement and prolonged antimicrobials. VISA causing MPA is associated with worse outcomes. We report the first time use of ceftaroline in the management of a VISA MPA. BACKGROUND

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Mycotic Pseudoaneurysm and Purulent Pericarditis Attributable to Methicillin-ResistantStaphylococcus aureus

Cited by 16 publications

References 21 publications

Healthy Adolescent with a Mycotic Aortic Aneurysm from Community-Acquired Methicillin-Resistant Staphylococcus aureus

Healthy Adolescent with a Mycotic Aortic Aneurysm from Community-Acquired Methicillin-Resistant Staphylococcus aureus

Infected aortic aneurysm, purulent pericarditis, and pulmonary trunk rupture caused by methicillin-resistant Staphylococcus aureus

Mycotic pseudoaneurysm by vancomycin-intermediateStaphylococcus aureus: a rare cause of persistent bacteraemia

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