RESUMO
INTRODUCTION: Tuberculosis (TB) is still a major global health issue. In over 75 % of all cases of mycotic aneurysm, TB spreads directly by eroding through the vascular wall. Aortic and innominate arteries are frequently the sites of tubercular aneurysms, primarily due to contiguous dissemination from pulmonary infection sites. We report a case of a saccular aneurysm at the distal common femoral artery associated with tuberculosis. CASE PRESENTATION: A 34-year-old man had the chief complaint of a voluminous pulsatile mass in the left thigh. We found a bruit on auscultation examination at the site of the mass. A computed tomography (CT) angiography showed a saccular aneurysm at the distal common femoral artery and stenosis at the proximal femoral profunda artery. A chest CT scan was conducted, and the result showed a ground-glass appearance and multiple enlarged lymph nodes. CLINICAL DISCUSSION: The patient was treated surgically by resection of the aneurysm and reconstruction with an inter-positional saphenous vein graft. Later, he was treated with a drug regimen for tuberculosis by pulmonologist. The patient was discharged with no post-operative complications. CONCLUSION: Patients with femoral artery aneurysms are at high risk of rupture and death by exsanguination. It can be a severe complication of tuberculosis, especially in immunocompromised patients. Although this was a very rare case, all surgeons must be aware. A combination of medical and surgical intervention is imperative. Careful clinical care postoperatively is mandatory because of the risk of repetitive anastomotic aneurysms and recurrent aneurysms in another vessel.
RESUMO
Streptococcus suis (S. suis) is a zoonotic pathogen that causes pneumonia, sepsis, endocarditis, and meningitis. S. suis is primarily found in the upper respiratory tract of pigs. To our knowledge, the first case of S. suis infection has resulted in pneumonia in Indonesia. A 40-year-old woman suffered from shortness of breath last month. The complaint worsened one week ago. She also complained of a productive cough with thick white phlegm. She has a history of late-stage cervical cancer. The patient's vital signs were normal, except for tachypnea. Vesicular breath sounds, no wheezing, and coarse lung crackles were discovered during a physical examination. A chest x-ray showed patchy airspace opacities and interstitial thickening throughout both lungs. The following results were obtained from routine laboratory leukocytosis. Gram stain of the sputum showed a few Gram-positive cocci, mostly in pairs. We confirmed this finding by performing the blood agar, and chocolate agar revealed small α-hemolytic and catalase-negative colonies. The strain was positive for penicillin and ceftriaxone in antimicrobial susceptibility testing. A combination of penicillin and ceftriaxone intravenous was utilized for definitive treatment. After completing a 14-day course of oral antibiotic medication, the patient was discharged. Her symptoms had subsided. This case should remind physicians about the possibility of cancer associated with S. suis infected patient and no clear history of exposure to pigs or other animals.
