CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
AFRICA
e5
graft, 14 mm in diameter. We also performed femoral-to-femoral
artery artificial graft bypass (8 mm in diameter) due to the total
occlusion of the left common iliac artery (Fig. 2).
Blood culture revealed
Salmonella enterica
, which was
treated with the antibiotic, Ertapenem at a dose of 1 g/day. His
symptoms of radiculopathy were relieved but fever persisted
despite surgical intervention and antibiotic treatment for a week.
A subsequent abdominal CT revealed a fluid-filled lesion with
rim enhancement expanding the left iliac and left psoas muscles.
We suspected abscess formation and therefore performed
CT-guided percutaneous catheter drainage, following which the
fever subsided within three days. After sustained treatment with
an intravenous antibiotic (Ertapenem: 1 g/day) for six weeks, and
an oral antibiotic (ciprofloxacin: 500 mg twice per day) for two
weeks, he was discharged in a stable condition. There were no
EVAR-related complications or recurrent infections noted at the
one-year out-patient follow up.
Discussion
The clinical non-specific symptoms of mycotic aortic aneurysm
present as lumbosacral radiculitis with sciatica and make
diagnosis challenging for clinicians.
3
When the infection process
begins in the aorta, the ulcerated artherosclerotic plaques become
infected, followed by thrombi deposits. The vasa vasorum
of the arterial wall becomes destroyed, resulting in repeated
Fig. 1.
Pseudolumen located over the distal aorta to the left of the common iliac artery (white arrow). The left common iliac artery
caused total compression and haematoma formation over the left psoas muscle with fat stranding (black arrows).
