Peripheral Mycotic Aneurysm with Enterococcus Faecalis Bacteremia - A Rare Case Report

週邊細菌性動脈瘤合併有糞腸球菌之菌血症－一罕見之病例報告

謝綺瀅(Chi-Ying Hsieh) ； 游彥辰(Yen-Chen Yu)

《臺灣整形外科醫學會雜誌》 28卷3期 (2019/09) Pp. 260-266

摘要

Background: Mycotic aneurysm is defined as an abnormal focal arterial dilation with irreversible vascular injury due to a pre-existing infection. The mortality and morbidity of mycotic aneurysm is high if the aneurysm is not treated promptly. Aim and Objectives: This case report is written aiming to highlight the unusual localities of the mycotic aneurysm and the pathogens causing infections without an apparent medical history. Multifaceted factors should be included to prevent delayed diagnosis and subsequent treatment measures. Materials and Methods: A 70-year-old man with a history of coronary artery disease who underwent coronary bypass surgery 6 months before this episode. He was admitted to our hospital due to acute tenderness and weakness of the left elbow accompanied with fever. Imaging studies (MRI) suggested myofasciitis with abscess formation. A mycotic aneurysm in the radial artery in the elbow region along with arterial-venous fistula and thrombus formation was incidentally found during surgical debridement. Results: Resection of the necrotic aneurysmal vessel with autologous vein graft reconstruction was performed. The hand circulation was competent after the surgery, and the wound healing went well. Bacterial culture of blood and necrotic tissue yielded Enterococcus faecalis. No signs of infectious endocarditis were identified on echocardiogram. The patient completed a 6-week antibiotic, oxacillin treatment, and his bacteremia status subsided. Conclusion: Peripheral mycotic aneurysms, especially in the upper extremities are rare; peripheral mycotic aneurysms with Enterococcus faecalis bacteremia are even scarce. Early diagnosis with a high index of suspicion, individualized treatment with medication, and surgical intervention are important for the successful management of these aneurysms.

關鍵字

peripheral mycotic aneurysm ； Enterococcus Facecalis Bacteremia ； infection

並列摘要

背景：細菌性動脈瘤是同時存在細菌性感染與局部異常的動脈擴張併不可逆之血管損傷；若無及時診治，這類案例會有高合併症發生率與高死亡率。目的及目標：藉由瞭解細菌性動脈瘤的不尋常發生位置與病原體，配合臨床上的早期懷疑，以避免這類案例的診斷與治療延遲。材料及方法：我們報告一位七十歲男性有冠狀動脈疾病，在該次住院六個月前接受過冠狀動脈繞道手術的病史。本次住院主訴為左手肘壓痛、無力合併發燒症狀，影像學檢查疑似肌腱炎併膿瘍形成，於是病人接受清創手術治療。然而術中意外發現一顆細菌性動脈瘤併動靜脈廔管與血栓形成。結果：我們改為病人進行已壞死的動脈瘤血管切除術與自體靜脈移植重建術，術後肢端循環與傷口恢復情形良好。追蹤血液與組織培養結果均顯示為糞腸球菌，心臟超音波顯示未有感染性心內膜炎的徵象。病人隨後接受為期六週的抗生素治療，症狀得到改善後並健康出院。結論：上肢的週邊細菌性動脈瘤實為罕見，尤其是糞腸球菌感染更為少見，臨床上的早期辨識診斷及適當的處置有助於這類案例的成功治療。