Kesiena Onoriode, Da Silva Rafael Carlos, Kumar Navin
Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA.
Cureus. 2021 Oct 22;13(10):e18963. doi: 10.7759/cureus.18963. eCollection 2021 Oct.
A contained ruptured mycotic abdominal aneurysm is one of the complications of infective endocarditis. It is a complication that physicians should entertain when patients with infective endocarditis present with a complaint of back pain. This case report aims to increase the awareness of the possibility of a rupture of a small size abdominal mycotic aneurysm. This is a 36-year-old female with a history of intravenous (IV) drug use and infective endocarditis secondary to methicillin-sensitive presented with acute right-sided lower back pain. Work-up revealed a contained ruptured 2.5 cm mycotic abdominal aneurysm. She had an open surgical repair of the abdominal aorta followed by a mitral valve replacement a week later and she was discharged home on antibiotics and an anticoagulant. Untreated, a mycotic aneurysm can expand quickly and has a higher likelihood of rupturing as compared to an atherosclerotic abdominal aortic aneurysm. A contained ruptured mycotic abdominal aneurysm can lead to a dramatic hemodynamic compromise when it becomes uncontained, hence it is prudent that it is acted after it is diagnosed. Most authors recommend prompt surgery for all patients irrespective of the size of the aneurysm. Younger age is a factor to consider in choosing a repair approach despite the complications associated with both open surgical and endovascular repair.
局限性破裂性霉菌性腹主动脉瘤是感染性心内膜炎的并发症之一。当感染性心内膜炎患者出现背痛主诉时，医生应考虑到这一并发症。本病例报告旨在提高对小尺寸霉菌性腹主动脉瘤破裂可能性的认识。这是一名36岁女性，有静脉注射毒品史，继发于甲氧西林敏感菌的感染性心内膜炎，出现急性右侧下背痛。检查发现一个2.5厘米的局限性破裂性霉菌性腹主动脉瘤。她接受了腹主动脉开放手术修复，一周后进行了二尖瓣置换，出院时带抗生素和抗凝剂回家。未经治疗，霉菌性动脉瘤会迅速扩大，与动脉粥样硬化性腹主动脉瘤相比，破裂的可能性更高。局限性破裂性霉菌性腹主动脉瘤一旦破裂，会导致严重的血流动力学不稳定，因此确诊后应谨慎处理。大多数作者建议对所有患者立即进行手术，无论动脉瘤大小。尽管开放手术和血管腔内修复都有并发症，但在选择修复方法时，年龄较小是一个需要考虑的因素。
