Primary aortoenteric fistula caused by an infected abdominal aortic aneurysm with Mycobacterium avium complex in an HIV patient.

Primary aortoenteric fistula (PAEF) is a rare but complex clinical entity requiring multimodality approach for diagnosis and treatment. We report the first ever case of upper gastrointestinal (UGI) hemorrhage caused by an aortoenteric fistula (AEF) secondary to Mycobacterium avium complex (MAC) in a patient with human immunodeficiency virus (HIV) infection. Esophagogastroduodenoscopy (EGD) showed an ulcer in the distal duodenum and a computed tomography (CT) scan confirmed a contained abdominal aortic aneurysm (AAA) rupture with an aorto-enteric fistula communicating with the third portion of the duodenum. Emergent surgery was undertaken which was lifesaving. A high index of suspicion, early diagnosis and prompt surgical intervention are crucial for survival of patient with PAEF.