CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 AFRICA 59 Mycotic abdominal aortic aneurysm: two cases caused by Salmonella enterica Nehir Tandogar, M Şeyda Velioğlu Öcalmaz Abstract A mycotic abdominal aortic aneurysm was detected on computed tomographic angiography of two male patients who were followed up after reporting symptoms of abdominal pain, malaise and fever of unknown origin. One of the patients’ aneurysm was repaired with a tubular graft and the other patient had endovascular aneurysm repair due to his high co-morbidity. From pre-operative cultures and a pathological examination of the surgical specimens, it was observed that the aneurysms had developed in the abdominal aorta due to Salmonella enterica, and broad-spectrum antibiotic therapy was started. We present these two cases of mycotic aneurysm due to Salmonella. The patients were discharged after the postoperative course of antibiotic treatments were completed. Keywords: aneurysm, abdominal aorta, graft, treatment, Salmonella Submitted 11/2/22, accepted 10/5/22 Published online 10/6/22 Cardiovasc J Afr 2023; 34: 59–62 www.cvja.co.za DOI: 10.5830/CVJA-2022-024 Mycotic aneurysm is caused by infection of the arterial wall due to bacteria or fungi.1,2 It is uncommon and treatment may be difficult.1 A septic embolism secondary to infective endocarditis or haematogenous spread of an infection are often the cause.2 No guidelines exist for the treatment of mycotic aneurysms and there is a high risk of mortality (10–40%) despite the development of new treatment modalities and technology.1,3,4 Although many bacteria may cause its aetiology, Staphylococcus aureus (22–28%) and Salmonella spp. (15–17%) are the most common pathogens.5-7 Vascular infection is one of the most important extra-intestinal involvements of Salmonella, and endovascular involvement usually causes abdominal aortic aneurysm.8 In this study, two successfully treated cases of mycotic aneurysm due to Salmonella enterica are presented. Case report 1 A 64-year-old male patient had been followed up in the infection service for 15 days with symptoms of left lower-extremity pain, weakness and fever of unknown origin. The patient was transferred to our service because computed tomographic angiography (CTA) detected a saccular abdominal aortic aneurysm, compatible with a mycotic aneurysm, with necrotic tissue and an abscess in the peri-aortic area (Fig. 1A, B). His history included type 2 diabetes mellitus (DM), hypertension, hyperlipidaemia and coronary artery disease. The patient’s vital signs were normal. On physical examination, no pathology was detected except for left costovertebral angle tenderness. Biochemistry tests of the infection markers showed the leukocyte count was 24.550 cells/mm3, neutrophil count was 21.630 cells/mm3 (88%), C-reactive protein (CRP) was 20 mg/dl, Fig. 1. CT angiography: saccular abdominal aortic aneurysm and contained rupture. Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey Nehir Tandogar, MD, nehirtandogar@gmail.com M Şeyda Velioğlu Öcalmaz, MD A B
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