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Diagnosis and treatment of ruptured mycotic infrarenal aortic aneurysm secondary to salmonella species.

Author

Bryan Rene Toledano,
Emily Mae Yap,
Warren S. Rondilla,
Joel Paz

Related Institution

Adult Cardiology - Philippine Heart Center

Publication Information

Publication Type
Research Project
Date
January 1-December 1, 2018

Abstract

Background --- Ruptured infected aortic (mycotic) aneurysm is a rare and life-threatening condition, early and proper initiation of antibiotics aside from aneurysmal repair is of paramount importance. The typhidot IgG and IgM as a supportive test might help with this dilemma, especially in negative blood culture and while waiting for aortic sample result.
Case --- A 47-year-old male Filipino with type 2 diabetes mellitus presented with severe back pain for 1 month and intermittent fever for 3 weeks. There was worsening of the back pain prompting consult. Complete blood count showed anemia and leukocytosis with predominance of neutrophils. On Computed Tomography Aortogram a segmental calcification and wall discontinuity in the right posterolateral wall of the infrarenal abdominal aorta with heterogenous collection in the retroperitoneal region was seen and aortic rupture secondary to mycotic aneurysm was considered. He underwent emergency abdominal aortic aneurysm repair with debridement, antibiotic lavage, aortoiliac grafting, anastomosis and omental packing. The typhidot IgG and IgM test was positive and was given Ceftriaxone 2gm/IV every 24 hours for six weeks. Blood cultures did not reveal significant growth of any pathogen. The aortic wall culture showed heavy growth for salmonella species sensitive to the antibiotic used, confirming and guiding the management. He was then discharged improved.
Conclusion --- Aside from the standard blood, aortic wall cultures, the typhidot test can also be a valuable tool for supportive diagnosis of salmonella as a cause for mycotic aortic aneurysm which can lead to early and proper initiation of antibiotics.

Physical Location

LocationLocation CodeAvailable FormatAvailability
Philippine Heart Center Medical Library CR.005.18 Fulltext Print Format

 
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