Achilli Pietro, Guttadauro Angelo, Bonfanti Paolo, Terragni Sabina, Fumagalli Luca, Cioffi Ugo, Gabrielli Francesco, De Simone Matilde, Chiarelli Marco
University of Milan - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy.
Department of Surgery, University of Milan-Bicocca, Istituti Clinici Zucchi, Via Zucchi, 24, 20900, Monza, Italy.
BMC Gastroenterol. 2017 Dec 29;17(1):170. doi: 10.1186/s12876-017-0728-0.
The burden of disease caused by Streptococcus agalactiae has increased significantly among older adults in the last decades. Group B streptococcus infection can be associated with invasive disease and severe clinical syndromes, such as meningitis and endocarditis.
We present the case of a 56-year-old man who developed multiple mycotic aneurysms of the right hepatic artery and massive splenic infarction as rare complications of Streptococcus agalactiae infective endocarditis. The patient underwent urgent right hepatic artery ligation and splenectomy. The postoperative course was complicated by an episode of hemobilia due to the rupture of a partially thrombosed mycotic aneurysm into the biliary tree. Thus, selective radiological embolization of the left hepatic artery branches was necessary.
To our knowledge, this is the first case reported of infected aneurysms of visceral arteries caused by Group B streptococcus infection. Clinical and laboratory findings were non-specific, while imaging features with computed tomography scan and angiography were highly suggestive. In our case, early recognition, culture-specific intravenous antibiotics and urgent surgical treatment combined with interventional radiology played a decisive role in the final result.
在过去几十年中，无乳链球菌引起的疾病负担在老年人中显著增加。B族链球菌感染可与侵袭性疾病和严重临床综合征相关，如脑膜炎和心内膜炎。
我们报告一例56岁男性患者，其发生了右肝动脉多发真菌性动脉瘤和大量脾梗死，这是无乳链球菌感染性心内膜炎罕见的并发症。患者接受了紧急右肝动脉结扎和脾切除术。术后病程因部分血栓形成的真菌性动脉瘤破裂进入胆管树导致胆道出血而复杂化。因此，有必要对左肝动脉分支进行选择性放射栓塞。
据我们所知，这是首例由B族链球菌感染引起的内脏动脉感染性动脉瘤的报道。临床和实验室检查结果无特异性，而计算机断层扫描和血管造影的影像学特征具有高度提示性。在我们的病例中，早期识别、针对性培养的静脉抗生素治疗以及紧急手术治疗联合介入放射学对最终结果起到了决定性作用。
