Case of non-typhoidal Salmonella spp mycotic popliteal artery aneurysm with concurrent deep vein thrombosis.

Mycotic aneurysms are a well-recognised complication of non-typhoidal Salmonella bacteraemia; the risk is increased in patients with atherosclerotic disease. The infrarenal abdominal aorta is the most common site of infection; lower extremity aneurysms are uncommon.1Here we present the case of a patient with cardiovascular disease and recurrent non-typhoidal Salmonella bacteraemia, who developed a left-sided popliteal artery mycotic aneurysm with secondary popliteal vein thrombosis. The aneurysm was diagnosed upon rupture, and managed with surgical excision and bypass graft. He went on to have a complete recovery.This case illustrates the importance of clinician awareness of popliteal artery endovascular infection as a rare but significant complication of non-typhoidal Salmonella bacteraemia, which should be considered in cases with cardiovascular risk factors, recurrent or persistent bacteraemia, and lower limb deep vein thrombosis.

Solid pancreas transplant outcomes with increased donor and recipient ages compared with reference ages: a systematic review.

BACKGROUND: Increased recipient and donor age are associated with worse solid organ pancreas transplant outcomes. However, donor and recipient age criteria vary between jurisdictions. We systematically reviewed studies reporting the association between transplanting older recipients and donors beyond current Transplantation Society of Australia and New Zealand (TSANZ) limits with solid pancreas transplant outcomes. AIMS: To review current outcomes of solid pancreas transplantation in recipients and donors over the TSANZ reference ages. METHODS: Studies comparing transplant outcomes between a reference-age and an older-age donor (>45 years) or recipient (≥50 years) cohort for solid pancreas transplantation were included. Primary outcomes were pancreas/kidney graft and patient survival at 1 and 5 years. Secondary outcomes were post-transplant complications (graft thrombosis, acute rejection and relaparotomy rates). RESULTS: Eleven studies were included (two studies assessing solid pancreas outcomes between older vs reference-aged donors and nine studies assessing outcomes between older vs reference-aged recipients). Seven of 11 studies were judged to be at high risk of bias. Primary and secondary outcomes were not significantly different between recipient age groups in nine studies. A sensitivity analysis of older versus reference-aged studies excluding studies at high risk of bias also showed non-inferior primary and secondary outcomes at 1 year. Two studies comparing outcomes by donor age showed worse graft survival but non-inferior patient survival with older donors. CONCLUSION: Increased donor or recipient age alone should not absolutely contraindicate solid pancreas transplantation, especially if other risk predictors are minimised.

Subclinical atypical haemolytic uremic syndrome relapse following discontinuation of eculizumab.

A 25-year-old man presented with microangiopathic haemolytic anaemia and acute kidney injury. With a normal ADAMTS-13 level, negative faecal shiga-toxin test and strong family history of atypical haemolytic uremic syndrome, he was commenced on eculizumab to good clinical response. Subsequent genetic testing revealed a heterozygous complement factor H mutation. Eculizumab was discontinued after 44 months of treatment, and he relapsed within 6 months, with the first sign being downtrending haptoglobin levels, with no other markers of haemolysis or thrombocytopaenia, 5 weeks prior to development of acute kidney injury. He was recommenced on eculizumab and to date still remains on it. This case highlights the unusual pattern of relapse and discusses the considerations for eculizumab discontinuation in patients with stable atypical haemolytic uremic syndrome receiving maintenance therapy.