Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan.
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan.
BMC Cardiovasc Disord. 2022 Apr 1;22(1):138. doi: 10.1186/s12872-022-02571-3.
An aortic graft implantation is an effective therapeutic method for various aortic diseases. However, it is known that sometimes these implanted grafts can be the foci of infections. Here we report a rare case of graft infection that presented multiple embolisms of aortic branches and peripheral organs.
A 63-year-old Japanese woman with a history of aortic graft implantation presented with occlusions of large arteries in different loci and time points, with elevation of non-specific inflammatory markers. Thoracic contrast-computed tomography (CT) captured vegetation in the descending aortic graft and the [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) showed accumulation of FDG in the same site, suggesting a graft infection. Despite all these suspicious findings, repeated blood culture examinations never detected any microorganisms. A diagnosis of Aspergillus graft infection was made based on an elevated serum β-D glucan (βDG) and a positive Aspergillus galactomannan (GM) antigen test. The patient subsequently had surgery with replacement of the descending aortic graft and anti-fungal drugs were instituted with significant improvement noted.
In the present case, the patient's specific feature in the anatomical vascular construction, past operation, and basal fundamental diseases collaboratively contributed to the pathogenesis of the present infection. It is important to recognize the risk of graft infection and conduct imaging studies when indicative symptoms emerge. The negativity in blood culture studies often makes detection of pathogenic microbes extremely difficult. This case suggests that non-cultural tests such as bDG and GM can be useful for diagnosis and starting appropriate anti-fungal drugs in the early stages.
主动脉移植物植入术是治疗各种主动脉疾病的有效方法。然而，已知这些植入的移植物有时可能成为感染的焦点。我们在此报告一例罕见的移植物感染病例，该病例表现为主动脉分支和外周器官的多处栓塞。
一名 63 岁的日本女性，有主动脉移植物植入史，出现不同部位和时间点的大动脉闭塞，非特异性炎症标志物升高。胸部对比计算机断层扫描（CT）显示降主动脉移植物内有赘生物，[18F]氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（[18F]FDG PET/CT）显示同一部位 FDG 积聚，提示移植物感染。尽管有这些可疑发现，但反复的血培养检查从未检测到任何微生物。基于血清β-D 葡聚糖（βDG）升高和曲霉半乳甘露聚糖（GM）抗原检测阳性，诊断为曲霉移植物感染。随后患者进行了手术，更换了降主动脉移植物，并使用抗真菌药物进行治疗，病情明显改善。
在本例中，患者在解剖血管结构、既往手术和基础基础疾病方面的特定特征共同导致了目前的感染。当出现提示症状时，认识到移植物感染的风险并进行影像学研究非常重要。血培养研究的阴性结果往往使检测病原体微生物变得极其困难。本病例提示，非培养试验，如βDG 和 GM，可用于早期诊断和开始适当的抗真菌治疗。
