RESUMO
Background: A mycotic aortic aneurysm is a rare type of aortic aneurysm that can have disastrous outcomes. Most mycotic aneurysms originate from infectious sources, such as trauma, vegetation in the heart, and adjacent infectious sources. If a mycotic aneurysm is diagnosed, it should be treated simultaneously with the primary source of the infection. Case Summary: Treatment was performed for a mycotic aneurysm of the brachial artery that occurred suddenly during treatment for a fever for which the primary source of infection had not been confirmed. The workup revealed that a mycotic aneurysm of the brachial artery was the cause of the fever, followed by aneurysms in the abdomen and lower extremities and even vegetation in the heart that was not initially present. The patient declined to undergo treatment for personal reasons. After 5 months, it was revealed that the abdominal aortic aneurysm, which was initially considered normal aorta, was ruptured; however, the aneurysm was successfully treated. Conclusions: A peripheral mycotic aneurysm may be associated with multiple aneurysms. Appropriate diagnosis and complete treatments are necessary to prevent fatal consequences.
Assuntos
Aneurisma Infectado , Aneurisma da Aorta Abdominal , Ruptura Aórtica , Humanos , Aneurisma da Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/complicações , Masculino , Ruptura Aórtica/microbiologia , Idoso , Artéria BraquialRESUMO
We report the case of a 48-year-old man, admitted for atrial fibrillation with rapid heart rate and intense chest pain. A quick evaluation revealed a giant aortic aneurysm with severe aortic regurgitation and pericardial fluid without a trace of aortic dissection. Because of high suspicion of aortic rupture, an emergency surgery was planned, and a Bentall procedure was performed. On examination of the aortic wall revealing vertical wrinkling with a tree bark aspect, suspicion of syphilitic aortitis arose. The diagnosis was confirmed through postoperative serologic testing and histological examination. Histopathologic differential diagnosis, special treatment and follow-up are presented.
Assuntos
Aneurisma Infectado/cirurgia , Ruptura Aórtica/prevenção & controle , Aortite/cirurgia , Implante de Prótese Vascular , Sífilis Cardiovascular/cirurgia , Administração Intravenosa , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Antibacterianos/administração & dosagem , Ruptura Aórtica/microbiologia , Aortite/diagnóstico por imagem , Aortite/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Penicilinas/administração & dosagem , Sífilis Cardiovascular/diagnóstico por imagem , Sífilis Cardiovascular/microbiologia , Resultado do TratamentoRESUMO
BACKGROUND: Mycotic aortic aneurysm constitutes a potentially devastating disease that necessitates prompt suspicion and diagnosis. There is no exact consensus for treatment, but removal of infected tissues and prolonged use of antimicrobials based on the identified causative microorganisms seem widely acceptable and have been similarly practiced worldwide. However, some patients still show no identified microorganisms. In this study, we sought to determine whether there are any clinical significance or differences of note in culture-negative mycotic aortic aneurysms. METHODS: Between October 2003 and August 2018, 71 patients were identified as treated for mycotic aortic aneurysms at a single tertiary institution. Review of medical records and imaging studies were completed to collect the following information: demographics, previous medical/surgical history regarding potential infection sources, laboratory and radiologic findings, clinical presentations, treatment method, and morbidity and mortality rates. For analysis, patients were categorized into two groups: the blood and/or tissue culture-positive (CP) group and the blood and/or tissue culture-negative (CN) group. The latter was further divided as CN with identified microorganism by molecular biologic methods [CN(+)] and CN with no identified microorganism [CN(-)]. RESULTS: More patients in the CP group were symptomatic than were in the CN(+) group (100% vs. 80%; Pâ¯=â¯0.034). However, identification of causative microorganisms did not result in a difference in symptom status upon comparing the [CPâ¯+â¯CN(+)] and [CN(-)] groups. Inflammatory markers were the most elevated in the CP group and least elevated in the CN(-) group. The aneurysm growth rate seemed slower in the CN(-) group than in the CN(+) and CP groups (1.3 vs. 3.4 vs. 9 mm/month respectively). Aneurysm rupture at initial presentation was more prevalent in the CP group (33.3%). 18F-Fluorodeoxyglucose-positron emission tomography showed increased uptake regardless of whether or not the microorganisms were identified. Early mortality and disease-specific mortality rates during the follow-up period were higher in the CP group but without statistical significance. CONCLUSIONS: Compared with the CP group, the CN groups appeared clinically less severe, and also exhibited a relatively less devastating course as exhibited by the slower aneurysm expansion rate and smaller number of ruptured aneurysms at the initial presentation.
Assuntos
Aneurisma Infectado/microbiologia , Aneurisma Aórtico/microbiologia , Ruptura Aórtica/microbiologia , Idoso , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/terapia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/terapia , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoAssuntos
Aneurisma Infectado/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Aortite/diagnóstico por imagem , Infecções por Clostridium/diagnóstico por imagem , Clostridium septicum , Idoso de 80 Anos ou mais , Aneurisma Infectado/microbiologia , Aneurisma Infectado/cirurgia , Ruptura Aórtica/microbiologia , Ruptura Aórtica/cirurgia , Aortite/microbiologia , Aortite/cirurgia , Infecções por Clostridium/complicações , Infecções por Clostridium/terapia , Feminino , Humanos , Tomografia Computadorizada por Raios XRESUMO
Mycotic pseudoaneurysms usually arise from an infectious arteritis or mycotic aneurysms secondary to weakening and destruction of the arterial wall resulting in a contained rupture. We report a case of a mycotic pseudoaneurysm affecting the aortic isthmus of the thoracic aorta which is an extremely rare infection. To our knowledge no case report of mycotic pseudoaneurysm of the aortic isthmus secondary to salmonella infection has thus far been described. The specific case we present is also unique in that it posed a diagnostic imaging dilemma where the initial imaging revealed a periaortic mass which could not be accurately characterized and only on subsequent imaging reveal itself to be a thrombosed mycotic pseudoaneurysm. We hope that our case report highlights to the medical community the high degree of suspicion one should have regarding pseudoaneurysms when dealing with a complex mass intimately related to a vascular structure.
Assuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Aneurisma da Aorta Torácica/microbiologia , Infecções por Salmonella/diagnóstico por imagem , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Aneurisma Infectado/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/microbiologia , Aortografia , Angiografia por Tomografia Computadorizada , Humanos , MasculinoRESUMO
Primary infected abdominal aortic aneurysm (AAA) is an uncommon presentation which can be associated with significant morbidity and mortality. In this report, we present 2 cases of infected AAAs less than 10 days after a transrectal ultrasound-guided (TRUS) prostate biopsy. A 63-year-old male presenting with sepsis and back pain 9 days after TRUS biopsy was found to have a 27-mm ectatic abdominal aorta which expanded to 59 mm in the course of a week, despite antibiotic therapy. He underwent successful surgical excision of the infected aortic aneurysm and reconstruction using a vein. A 55-year-old male presented similarly, 7 days after prostate biopsy with a 60-mm aortic aneurysm. His aneurysm ruptured 2 days before planned intervention-he did not survive an emergency repair. In both cases, aortic tissue biopsies confirmed growth of Escherichia coli. Preexistence of an aortic aneurysm was not known in either case as neither patient had imaging of the abdominal aorta. We postulate the pathophysiology was due to hematogenous spread.
Assuntos
Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/microbiologia , Ruptura Aórtica/microbiologia , Infecções por Escherichia coli/microbiologia , Biópsia Guiada por Imagem/efeitos adversos , Próstata/patologia , Ultrassonografia de Intervenção/efeitos adversos , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Dor nas Costas/microbiologia , Infecções por Escherichia coli/diagnóstico por imagem , Infecções por Escherichia coli/cirurgia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sepse/microbiologia , Resultado do TratamentoRESUMO
BACKGROUND: Intravesical instillation of Bacillus Calmette-Guérin (BCG) is an effective and widely used treatment for patients with in situ bladder cancer. Major complications are quite uncommon, but a systemic dissemination of the attenuated strain of Mycobacterium bovis is possible. Few cases of aortic rupture caused by M bovis infection are described in literature. METHODS: A 70-year-old male, treated 3 months before with BCG instillation, presented to the emergency department because of a ruptured abdominal aortic aneurysm. The patient was hemodynamically stable, with a "hostile" abdomen. Therefore, an Endologix AFX endograft was deployed. During the postoperative period, his blood inflammatory markers increased, suspicious of a graft infection. Single-photon emission computed tomography (CT)/CT scan showed aortic increased uptake. Antibiotic therapy was continued, but after some days, the patient presented with hematemesis, and the CT scan showed an aortoenteric fistula. In emergency, the infected graft and aneurysm were removed, enteric fistula was closed, and an axillobifemoral bypass was performed. The patient died 25 days after endovascular aneurysm repair explantation. RESULTS: Despite the high suspicion of mycotic aortic aneurysm and graft infection by M bovis, there is no proof of this theory because of the absence of any positive culture test. M bovis is a slow-growing bacteria, and specific culture tests are required to identify it; indeed, all our blood and intraoperative samples were positive to other bacteria, probably the contaminant ones. CONCLUSIONS: Mycotic aneurysm is an extremely rare complication of intravesical BCG therapy, but it must be taken into consideration in patients with rapidly growing aortic aneurysms or rupture of a normal aorta, who have been previously submitted to this kind of instillation.
Assuntos
Aneurisma Infectado/microbiologia , Antineoplásicos/efeitos adversos , Aneurisma da Aorta Abdominal/microbiologia , Ruptura Aórtica/microbiologia , Vacina BCG/efeitos adversos , Mycobacterium bovis/patogenicidade , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Antineoplásicos/administração & dosagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Aortografia/métodos , Vacina BCG/administração & dosagem , Angiografia por Tomografia Computadorizada , Evolução Fatal , Humanos , Masculino , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Resultado do TratamentoRESUMO
OBJECTIVE: Mycotic aortic aneurysms are rare, life threatening, and complex. This nationwide study aimed to assess outcome after repair of mycotic thoracic aortic aneurysms (MTAAs). METHODS: Patients treated in Sweden for MTAAs between 2000 and 2016 were identified in the Swedish vascular registry (2010-16) and local patient registries (2000-09). Primary outcome was survival, and secondary outcomes included surgical strategy, rate of infection related complications (IRC), and re-operations. RESULTS: Fifty-two patients (median age 71 ± 8.1 years; 28 [54%] men, 13 [25%] ruptured) were identified (3.6% of all thoracic aortic aneurysm repairs in Sweden). Aneurysm location was aortic arch (n = 6; 11%), descending aorta (n = 42; 81%), and multiple locations (n = 4; 8%). Twenty-nine (56%) patients had positive cultures; the most prevalent agent was Staphylococcus aureus (n = 16; 31%). Operative techniques included thoracic endovascular aortic repair (TEVAR; n = 35 [67%]), fenestrated/branched TEVAR (n = 8; 15%), hybrid repair (n = 7; 14%), and open patch repair (n = 2; 4%). Survival was 92% (95% confidence interval [CI] 88-96) at 30 days, 88% (95% CI 84-93) at three months, 78% (73-84) at one year, and 71% (64-77) at five years. The mean follow up among survivors (> 90 days) was 45 months (range 4-216 months). Antibiotics were administered for a median of 15 weeks (range 0-220 weeks). IRCs occurred in nine patients (17%): sepsis (n = 3), graft infection (n = 3), recurrent mycotic aneurysm (n = 1), aorto-oesophageal/bronchial fistula (n = 2). Six (67%) IRCs were fatal; 80% occurred within the first year. Re-operations were performed in nine patients (17%). CONCLUSIONS: TEVAR was often used as treatment for MTAAs, with acceptable short- and long-term survival when compared with open cohorts in the literature. IRCs are of concern and warrant follow up and long-term antibiotic treatment.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/microbiologia , Ruptura Aórtica/microbiologia , Procedimentos Endovasculares/métodos , Infecções Estafilocócicas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/epidemiologia , Aneurisma da Aorta Torácica/epidemiologia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/epidemiologia , Ruptura Aórtica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologia , Análise de Sobrevida , Suécia/epidemiologia , Resultado do TratamentoRESUMO
INTRODUCTION: The increase in the incidence of tuberculosis in developing countries has resulted in increased reporting on more related complications. We report the successful management of an intraoperative spontaneous rupture of a tuberculous pseudo aneurysm associated with spinal tuberculosis. METHODOLOGY: We report the case of a 66 years old woman diagnosed with spinal tuberculosis of the T3/T4 vertebrae. During an anterior approach surgical reconstruction for the degenerative vertebrae, massive hemorrhage was observed after the removal of a portion of the prevertebral fascia of the affected vertebrae. This led to the exploration of the hilar fascia for the possibility of hilar hemorrhage, and when no hemorrhage was observed, aneurysm rupture was suspected. A portion of the hilar fascia was then sutured to the prevertebral fascia and the hemorrhage was partially controlled. RESULTS: On the 32nd month post-operative follow-up, the symptoms of chest and back pain had disappeared and the tuberculous lesion eradicated. CONCLUSION: Presently, there are few reports on the successful treatment of intraoperative spontaneous rupture of tuberculous pseudoaneurysms. We therefore report on the successful management of such a case.
Assuntos
Falso Aneurisma/microbiologia , Aneurisma Aórtico/microbiologia , Ruptura Aórtica/microbiologia , Tuberculose da Coluna Vertebral/microbiologia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Feminino , Humanos , Radiografia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/cirurgiaAssuntos
Ruptura Aórtica/cirurgia , Parada Circulatória Induzida por Hipotermia Profunda/efeitos adversos , Infecções Estafilocócicas/complicações , Procedimentos Cirúrgicos Vasculares/métodos , Antibacterianos/uso terapêutico , Ruptura Aórtica/complicações , Ruptura Aórtica/microbiologia , Pré-Escolar , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgiaRESUMO
Systemic side effects, including sepsis, due to bacille Calmette-Guérin treatment for carcinoma in situ in the bladder, are observed in 15% of the patients. In rare cases, patients have developed systemic infections and mycotic aneurysms. In this case report, a 72-year-old man developed a mycotic aortic aneurysm, and the appropriate tuberculostatic drugs had no effect on his systemic infection. He was successfully treated surgically, replacing the affected aortic segment with an autologous venous graft, resulting in complete remission. A follow-up PET-CT three months later showed no sign of ongoing aortic infection.
Assuntos
Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/microbiologia , Ruptura Aórtica/microbiologia , Vacina BCG/efeitos adversos , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Animais , Aorta Abdominal/transplante , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Vacina BCG/uso terapêutico , Carcinoma in Situ/tratamento farmacológico , Bovinos , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Mycobacterium bovis/isolamento & purificação , Transplante Autólogo , Tuberculose Bovina/tratamento farmacológico , Tuberculose Bovina/microbiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Enxerto VascularAssuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Aortite/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Infecções por Salmonella/cirurgia , Salmonella enterica/isolamento & purificação , Acidentes de Trânsito , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/microbiologia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/microbiologia , Aortite/diagnóstico por imagem , Aortite/microbiologia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Evolução Fatal , Humanos , Masculino , Infecções por Salmonella/diagnóstico por imagem , Infecções por Salmonella/microbiologia , Stents , Resultado do TratamentoRESUMO
OBJECTIVES: The outcome of endovascular repair (EVAR) for acute thoraco-abdominal aortic aneurysm (TAAA) is reported and the applicability of the t-Branch off the shelf (OTS) device is determined. METHODS: Interrogation of a prospectively maintained database identified all patients who underwent EVAR for acute TAAA between September 2012 (when the first non-elective t-Branch case was performed) and November 2015. Early and medium-term outcomes were analysed. Survival and re-intervention-free survival were calculated by Kaplan-Meier analysis. RESULTS: A total of 39 patients (27 men; mean ± SD age, 72 ± 8 years) were treated for acute symptomatic (n = 29) or ruptured (n = 10) TAAA (20 anatomical extent I-III, 19 extent IV). Fourteen patients had mycotic aneurysms. The mean aneurysm diameter was 80 ± 20 mm. The mean ± SD follow-up was 21.4 ± 15.4 months. Surgeon modified fenestrated EVAR was used in 24 patients, chimney/periscope EVAR in two, and t-Branch in 13 (33%) patients. Aortic coverage was greater than 40 mm above the coeliac axis in all patients. A total of 127 target vessels (TVs) were preserved (mean 3.3 per patient) and two occluded within 30 days. The 30 day mortality was 26%. Four (10%) patients developed spinal cord ischaemia (SCI): two with paraplegia died within 30 days, and two with paraparesis recovered completely with blood pressure manipulation and cerebrospinal fluid drainage. Estimated overall survival (±SD) at 12 and 24 months was 71.8 ± 7.2% and 63.2 ± 7.9%, respectively. Estimated freedom from re-intervention at 12 and 24 months was 93 ± 4.8% and 85.3 ± 6.8%, respectively. CONCLUSIONS: EVAR for acute TAAA is associated with acceptable early and mid-term results in patients who have no other treatment options. Only one third of these patients were suitable for the t-Branch device, indicating that further advances in device design are required to treat the majority of acute TAAA patients with commercially available OTS technology.
Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Complicações Pós-Operatórias/epidemiologia , Doença Aguda/mortalidade , Idoso , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Aneurisma da Aorta Torácica/microbiologia , Aneurisma da Aorta Torácica/mortalidade , Ruptura Aórtica/microbiologia , Ruptura Aórtica/mortalidade , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Isquemia/epidemiologia , Isquemia/etiologia , Estimativa de Kaplan-Meier , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Desenho de Prótese , Fatores de Risco , Medula Espinal/patologia , Stents , Resultado do TratamentoAssuntos
Ruptura Aórtica/enzimologia , Ruptura Aórtica/microbiologia , Metaloproteinase 8 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Pneumonia Estafilocócica/complicações , Pneumonia Estafilocócica/enzimologia , Staphylococcus aureus/isolamento & purificação , Idoso de 80 Anos ou mais , Evolução Fatal , Humanos , Masculino , Pneumonia Estafilocócica/microbiologiaRESUMO
We report, to our knowledge, the first case of a rare syphilitic infrarenal aortouniiliac aneurysm with contained rupture that presented with midepigastric abdominal pain. Review of the patient's medical history revealed untreated syphilis and poorly treated congestive heart failure. Given his comorbidities, the patient was treated with an emergent endovascular aneurysm repair. His 30-day postoperative recovery period was uneventful, and follow-up imaging revealed complete resolution of the aneurysms. Syphilitic infrarenal aortic aneurysm is currently considered a rare entity in this era of antibiotics. The present article provides a brief case report and short review of literature pertaining to syphilitic aortic aneurysms.
Assuntos
Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/microbiologia , Ruptura Aórtica/microbiologia , Sífilis Cardiovascular/microbiologia , Dor Abdominal/etiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/cirurgia , Resultado do TratamentoRESUMO
Descending necrotizing mediastinitis (DNM) is a life-threatening disease which often develops from a purulent infection of the oral cavity and is associated with high rates of mortality. Here we report the case of a young patient who died from an aortic arch rupture in context of DNM developed from an odontogenic infection caused by Prevotella buccae. Based on the current knowledge on this very rare vascular complication, we discuss factors that may have contributed to this fatal issue and future issues to optimize care provided to patients.
Assuntos
Aorta Torácica/microbiologia , Ruptura Aórtica/microbiologia , Infecções por Bacteroidaceae/microbiologia , Infecção Focal Dentária/microbiologia , Mediastinite/microbiologia , Dente Serotino/microbiologia , Prevotella/isolamento & purificação , Antibacterianos/uso terapêutico , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/terapia , Infecções por Bacteroidaceae/complicações , Infecções por Bacteroidaceae/diagnóstico , Infecções por Bacteroidaceae/terapia , Desbridamento , Drenagem , Evolução Fatal , Feminino , Infecção Focal Dentária/complicações , Infecção Focal Dentária/diagnóstico , Infecção Focal Dentária/terapia , Humanos , Mediastinite/diagnóstico , Mediastinite/terapia , Dente Serotino/cirurgia , Necrose , Toracotomia , Tomografia Computadorizada por Raios X , Extração Dentária , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Adjuvant therapy with bacillus Calmette-Guerin (BCG), a live attenuated strain of Mycobacterium bovis, has become the treatment of choice for low-risk superficial bladder carcinoma following transurethral resection of the bladder. Complications following vesical BCG instillations are uncommon but, in some cases, severe side-effects can occur such as sepsis or mycotic aneurysm. Besides usual laboratory techniques used for the diagnosis of Mycobacterium tuberculosis complex (MTBC) infections (smear microscopy and cultures), commercial immunochromatographic assays detecting MBP64, a 24 kDa M. tuberculosis complex-specific secretory protein, can rapidly distinguish MTBC and non-tuberculosis mycobacteria (NTM). MPB64 is found in M. tuberculosis, M. bovis and some but not all substrains of M.bovis BCG. Therefore, these immunochromatographic tests can lead to false negative results and delayed bacteriological diagnosis depending on the presence or absence of MPB64 protein in BCG substrains used for intravesical therapy. CASE PRESENTATION: We report the case of a 78-year-old male patient who was admitted to the hospital because of a 1-month history of unexplained fever, thrill, weight-loss and general malaise. His past medical history was marked by a non-muscle-invasive bladder carcinoma treated by transurethral resection followed by BCG instillations (Oncotice, Merck, USA). The patient was initially treated for a urinary tract infection but as fever persists after 72 h of antibiotherapy, urinary tract ultrasound was performed and revealed a large abdominal aortic aneurysm confirmed by computed tomography. Surgery was performed after multidisciplinary discussion. Direct smear of perioperative samples revealed acid-fast bacilli and both solid and liquid cultures were massively positive. Rapid identification of the positive mycobacterial culture was performed using an immunochromatographic assay based on the detection of the Mycobacterium tuberculosis MPB 64 antigen. The result was negative for Mycobacterium tuberculosis complex. After review of the medical record, a polymerase chain reaction (PCR) was performed and gave a positive result for M. tuberculosis complex. Anti-tuberculosis therapy was started immediately and the patient evolved favorably. CONCLUSIONS: Through this case, we showed how the utilisation of MPB64 immunochromatographic assays can provide misleading information due to the variable presence of this protein among the different BCG strains. This case further illustrates the utility of rapid TB complex-specific PCR assays which provide a more reliable identification of all MTBC species.