Dodd James, Mwipatayi Bibombe, Louw Amber, Joseph Simon, Picazo-Pineda Fernando
Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia.
Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia; University of Western Australia, School of Surgery, Perth, Australia.
Int J Surg Case Rep. 2024 Dec;125:110424. doi: 10.1016/j.ijscr.2024.110424. Epub 2024 Oct 10.
Melioidosis is caused by Burkholderia pseudomallei and primarily affects non-vascular organ systems. We present a case of a melioidotic penetrating aortic ulcer (PAU) with unusual clinical features of vascular infection. The patient was successfully treated with a single-stage neoaortoiliac system procedure, highlighting the challenges in managing melioidotic aortic infections.
We present a case of melioidotic PAU that was successfully treated using a single-stage neoaortoiliac system procedure. A 70-year-old male with type 2 diabetes and ischemic heart disease presented with acute abdominal and back pain, later found to have an infrarenal PAU without aneurysmal changes. Following an emergency endovascular aortic repair (EVAR), blood cultures revealed Burkholderia pseudomallei bacteraemia, leading to the diagnosis of melioidosis-associated aortitis. The patient underwent a complex surgical procedure to remove the infected aorta and reconstruct it using a neoaortoiliac system, followed by a challenging recovery that included wound infection, prolonged antibiotic therapy, and subsequent hospitalization for sepsis. Despite complications, the patient remains alive and functionally independent 15 months post-surgery.
Burkholderia pseudomallei, found in contaminated soil and water, can lead to severe infections, including mycotic aneurysms, with a high mortality rate despite treatment. Management of vascular involvement is complex, often requiring emergency interventions like EVAR to enable survival for definitive treatment.
This case emphasizes the importance of recognizing melioidosis as a potential cause of infectious aortitis, particularly in patients with a travel history to endemic regions.
类鼻疽病由类鼻疽伯克霍尔德菌引起，主要影响非血管器官系统。我们报告一例类鼻疽性穿透性主动脉溃疡（PAU），具有血管感染的不寻常临床特征。患者通过单阶段新主动脉-髂动脉系统手术成功治疗，突出了管理类鼻疽性主动脉感染的挑战。
我们报告一例类鼻疽性PAU，通过单阶段新主动脉-髂动脉系统手术成功治疗。一名患有2型糖尿病和缺血性心脏病的70岁男性出现急性腹痛和背痛，后来发现有肾下PAU且无动脉瘤改变。在进行紧急血管内主动脉修复（EVAR）后，血培养显示类鼻疽伯克霍尔德菌菌血症，导致诊断为类鼻疽病相关性主动脉炎。患者接受了复杂的外科手术，切除感染的主动脉并用新主动脉-髂动脉系统进行重建，随后是具有挑战性的恢复过程，包括伤口感染、延长的抗生素治疗以及随后因败血症住院。尽管有并发症，但患者在手术后15个月仍存活且功能独立。
类鼻疽伯克霍尔德菌存在于受污染的土壤和水中，可导致严重感染，包括霉菌性动脉瘤，尽管进行了治疗但死亡率很高。血管受累的管理很复杂，通常需要像EVAR这样的紧急干预措施以确保存活以便进行确定性治疗。
该病例强调了认识到类鼻疽病作为感染性主动脉炎潜在病因的重要性，特别是在有前往流行地区旅行史的患者中。
