Mahfood Haddad Toufik, Vallabhajosyula Saraschandra, Sundaragiri Pranathi Rao, Vivekanandan Renuga
Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
Division of Infectious Diseases, Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
BMJ Case Rep. 2015 Apr 1;2015:bcr2014209003. doi: 10.1136/bcr-2014-209003.
Pseudoaneurysms are vessel wall ruptures, that are often mistaken for deep vein thrombosis (DVT). A middle-aged man presented with right leg pain, swelling and erythema. His history was significant for persistent Staphylococcus aureus bacteraemia. Ultrasound revealed subacute DVT and laboratory parameters were suggestive of sepsis. He was started on intravenous heparin and antimicrobials. Owing to persistent anaemia despite blood transfusion, MRI of the right thigh was obtained. It revealed a 13×17 cm superficial femoral artery infected mycotic pseudoaneurysm (MPA) with a fresh haematoma. The patient underwent arterial ligation and extensive debridement. Intraoperative cultures revealed daptomycin-resistant vancomycin-intermediate S. aureus (VISA) and he was managed with 6 weeks of intravenous ceftaroline. MPAs are most common in the femoral artery and form <1% of aneurysms. Therapy involves surgical debridement and prolonged antimicrobials. VISA causing MPA is associated with worse outcomes. We report the first time use of ceftaroline in the management of a VISA MPA.
假性动脉瘤是血管壁破裂，常被误诊为深静脉血栓形成（DVT）。一名中年男性出现右腿疼痛、肿胀和红斑。他有持续的金黄色葡萄球菌菌血症病史。超声显示亚急性DVT，实验室检查结果提示脓毒症。他开始接受静脉注射肝素和抗菌药物治疗。尽管输血后仍持续贫血，遂对右大腿进行了磁共振成像（MRI）检查。结果显示一个13×17厘米的股浅动脉感染性真菌性假性动脉瘤（MPA），伴有新鲜血肿。患者接受了动脉结扎和广泛清创术。术中培养发现对达托霉素耐药的万古霉素中介金黄色葡萄球菌（VISA），并对其进行了为期6周的静脉注射头孢洛林治疗。MPA最常见于股动脉，占动脉瘤的比例不到1%。治疗包括手术清创和长期使用抗菌药物。导致MPA的VISA与更差的预后相关。我们报告了首次使用头孢洛林治疗VISA MPA的情况。
