Itagaki Hideya, Ooizumi Tomoya, Sanada Chiho, Abe Yoshinobu, Endo Tomoyuki
Department of Emergency and Disaster Medicine, Tohoku Medical and Pharmaceutical University Hospital, Sendai, JPN.
Department of Emergency Medicine, South Miyagi Medical Center, Sendai, JPN.
Cureus. 2024 Feb 22;16(2):e54674. doi: 10.7759/cureus.54674. eCollection 2024 Feb.
Infected aortic aneurysm is a rare but fatal disease that occurs through various mechanisms. In this report, we describe the case of a patient who was hospitalized for acute pneumonia and developed an infected aortic aneurysm in the descending aorta during the hospitalization. A 73-year-old Japanese man presented to the emergency department with a chief complaint of fever. He had a history of chronic renal failure due to nephrosclerosis and was on regular hemodialysis three times a week. The patient presented with an elevated inflammatory response, anemia, and low platelet counts after various tests. Computed tomography (CT) showed ground-glass opacity in the left lung with a small amount of pleural effusion, leading to a diagnosis of pneumonia. The patient was admitted to the hospital on the same day, and a course of antibiotics (ceftriaxone [CTRX]) was started. On the fourth day of hospitalization, (MSSA) was detected in the blood sample, which was collected from the patient on the day of admission. The patient was treated for MSSA pneumonia and bacteremia, and the antibiotics were changed to cefazolin (CEZ). Treatment with antimicrobials resulted in a negative blood culture retest on day 5 and improvement of the inflammatory response. On the 12th day, improvements in pneumonia and pleurisy were observed on the CT scan; however, an abnormal bulge was seen on the dorsal side of the descending thoracic aorta with suspected partial vessel wall disruption, suggesting a ruptured infected aortic aneurysm. Despite treatment with antibiotics, the thoracic descending aortic aneurysm continued to dilate with progressing rupture, and the patient died on the 25th day of hospitalization. This is the first report of an infected aneurysm caused by Staphylococcus aureus, despite a negative blood culture. Patients at high risk might develop infected aneurysms, and the possibility of rapid dilation should always be considered.
感染性主动脉瘤是一种罕见但致命的疾病，其发病机制多样。在本报告中，我们描述了一例因急性肺炎住院的患者，在住院期间降主动脉发生了感染性主动脉瘤。一名73岁的日本男性因发热为主诉就诊于急诊科。他有因肾硬化导致的慢性肾衰竭病史，每周定期进行三次血液透析。经过各项检查，患者出现炎症反应升高、贫血和血小板计数降低。计算机断层扫描（CT）显示左肺磨玻璃影伴少量胸腔积液，诊断为肺炎。患者于同日入院，并开始使用抗生素（头孢曲松[CTRX]）治疗。住院第四天，在入院当天采集的血样中检测到甲氧西林敏感金黄色葡萄球菌（MSSA）。患者接受了MSSA肺炎和菌血症的治疗，抗生素改为头孢唑林（CEZ）。抗菌治疗使第5天的血培养复查结果为阴性，炎症反应有所改善。第12天，CT扫描显示肺炎和胸膜炎有所改善；然而，在降主动脉后侧可见异常凸起，怀疑部分血管壁破裂，提示感染性主动脉瘤破裂。尽管使用了抗生素治疗，胸降主动脉瘤仍继续扩张并逐渐破裂，患者于住院第25天死亡。这是首例尽管血培养阴性但由金黄色葡萄球菌引起的感染性动脉瘤报告。高危患者可能会发生感染性动脉瘤，应始终考虑快速扩张的可能性。
