McCann John F, Fareed Azhar, Reddy Sukanya, Cheesbrough John, Woodford Neil, Lau Sally
J Med Case Rep. 2009 Mar 10;3:6453. doi: 10.1186/1752-1947-3-6453.
Mycotic aneurysms account for a small proportion of all aneurysms. Escherichia coli a gram-negative organism, is recognised as a rare cause of aortic aneurysm. We report two cases of mycotic aneurysm caused by the same strain of multi-resistant Escherichia coli. The purpose of this case report is to highlight the possibility that this strain may be associated with an increased risk of endovascular infection especially in extra-aortic sites. These aneurysms can be difficult to detect and can have serious consequences.
In case one, the patient presented with symptoms and signs of septicaemia secondary to a urinary tract infection. Despite adequate treatment the patient continued with pyrexia and raised inflammatory markers, therefore a series of CT scans of the abdomen and thorax were performed, which revealed two intra-thoracic pseudo-aneurysms with associated haematomas. In case two, the patient also developed Escherichia coli septicaemia. On day 44 he developed a swelling on the right side of his neck. An ultrasound scan showed a pseudoaneurysm of the right common carotid artery.
Whilst a case report cannot prove that a heightened risk exists, we suggest that it is an area worthy of further surveillance. We recommend when older patients with atheromatosis develop prolonged Escherichia coli septicaemia, the possibility of an infected aneurysm should be borne in mind.
真菌性动脉瘤在所有动脉瘤中占比很小。大肠杆菌作为一种革兰氏阴性菌，被认为是主动脉瘤的罕见病因。我们报告了两例由同一株多重耐药大肠杆菌引起的真菌性动脉瘤病例。本病例报告的目的是强调这种菌株可能与血管内感染风险增加有关，尤其是在主动脉外部位。这些动脉瘤可能难以检测，并且可能会产生严重后果。
在病例一中，患者因尿路感染出现败血症的症状和体征。尽管进行了充分治疗，患者仍持续发热且炎症指标升高，因此进行了一系列腹部和胸部CT扫描，结果显示两个胸内假性动脉瘤并伴有血肿。在病例二中，患者也发生了大肠杆菌败血症。在第44天，他右侧颈部出现肿胀。超声扫描显示右侧颈总动脉假性动脉瘤。
虽然病例报告不能证明存在更高的风险，但我们认为这是一个值得进一步监测的领域。我们建议，当患有动脉粥样硬化的老年患者发生长时间大肠杆菌败血症时，应考虑感染性动脉瘤的可能性。
